Vesicovaginal fistula (VVF) is an abnormal channel between
bladder and vagina that results in urinary leakage. It is usually
associated with gynecologic procedures such as abdominal hysterectomy. Surgical repair remains the primary method of
treatment after a failed attempt with conservative measures.
Nowadays, several surgical techniques have been developed for
VVF treatment depending on the etiology, location, severity, size
of the fistula and experience of the surgeon. Laparoscopic repair
of VVF has become the first-line approach because of its safety
and effective minimally invasiveness. We describe our experience
with laparoscopic VVF repair.
From December 2001 to December 2007, we performed
laparoscopic repair operations for 5 patients ranged from 34 to
65 years of age (mean age 48.6 ± 3.2 years) who were diagnosed
as VVF. The fistulas of all 5 cases were the results of gynecologic
surgical procedures and cystoscopy could reveal their fistulous
opening between the bladder and vagina.
First of all, A Foley catheter was placed vaginally through the
fistula and pulled out into the bladder guided by cystoscopy.
A primary 10 mm port was inserted at the umbilicus, and then
established the pneumoperitoneum routinely. Two other ports
(5 and 10 mm) were placed in the inferior abdominal wall. Then,
the lateral peritoneum was opened with endoscopic scissors
and the vesico-vaginal space was precisely developed until the
bladder was completely freed posteriorly from the vaginal wall
and the catheter could be seen. After the remove of catheter, the
fistulous tract and unhealthy tissue margins should be dissected
carefully. Subsequently, the openings of the tract both on the
bladder and vagina sides were sutured and closed with Vicryl. A
suprapubic drain tube was left in place and bladder drainage was
accomplished by an urinary indwelling of a Foley catheter.
All 5 operations were successfully completed. There was no
conversion to open in all patients. There were no intraoperative
or postoperative complications occurred. The mean operative
time was 155 min (range 90 to 240 min), which is similar with
the open surgical group (155 min:135 min). The mean blood
loss ranged from 40-80 mL (mean loss 62 mL), which is less
than the open surgical group (62 mL : 151 mL). Compared
with the open surgical group, the time of postoperative recovery
of intestinal function and postoperative hospitalization also
were shortened obviously. After a follow up of 12 months, no
recurrence was found.
Based on our clinical practices and experiences, there are two
key points to insure the success of operation: the precise location
and confirmation of the fistula, the smooth coordination of
laparoscopy and cystoscopy. We believe that laparoscopic repair
of vesicovaginal fistula is a feasible, effective, and mini-invasive
approach for the treatment of vesicovaginal fistula.