Laparoscopic extravesical vesicovaginal fistula repair: our technique and 15-year experience

Abstract

Introduction and hypothesis: Two types of laparoscopic vesicovaginal fistula (VVF) repairs, the traditional transvesical (O’Conor) and extravesical techniques, dominate the literature. We present our 15-year experience of primary and recurrent cases of VVF utilizing an extravesical technique, which we first described in 1999. Methods: An IRB approved retrospective study revealed 44 female patients with either primary or recurrent VVF. Laparoscopic extravesical repair was performed without an omental flap in the majority of cases. A three-layer closure technique was performed utilizing a double-layer bladder closure and a single-layer vaginal closure followed by bladder testing. A suprapubic catheter was utilized for 2–3 weeks postoperatively for bladder decompression. Results: A review of our experience reveals a 97 % (32 out of 33) cure for primary VVF and 100 % (11 out of 11) rate for recurrent fistulas, with an overall cure rate of 98 % (43 out of 44) at a mean follow-up of 17.3 months (range 3–64). An omental flap was not utilized in 98 % of patients (43 out of 44), with a success rate of 98 % (42 out of 43). The mean estimated blood loss was 39 mL (range 0–450), mean hospital stay was 1.1 days (range 1–3), and none of the patients suffered any major intra- or postoperative complications. None of the patients required a conversion to open laparotomy. Conclusions: Based upon our experience we believe that performing laparoscopic extravesical VVF repair using a three-layer closure technique without an interposition omentum is a safe, effective, minimally invasive technique with excellent cure rates in an experienced surgeon’s hands.