Laparoscopic repair of vesico-vaginal fistula without intentional cystotomy and guided by vaginal transillumination

• Published in: Actas urológicas españolas (English ed.) 2012-04, Vol.36 (4), p.252-258
• Main Author: García-Segui, A
• Format: Article
• Language: English
• Subjects: Fistula; Fístula; Fístula vésico-vaginal; Laparoscopia; Laparoscopy; Surgical technique; Técnica quirúrgica; Urology; Vesico-vaginal fistula
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2012.07.007

Abstract Objectives Repair of vesico-vaginal fistula (VVF) by laparoscopy provides excellent exposure, which facilitates its implementation through small cystotomy. In some cases it is difficult to locate the fistula without prior opening of the bladder. We present a maneuver using vaginal transillumination to locate the fistula and to reduce the size of the bladder opening during laparoscopic repair without intentional cystotomy. Material and methods A total of 4 patients with supra-trigonal FVV produced post-hysterectomy received laparoscopic repair. All patients underwent physical examination, dye test, urethrocystoscopy and intravenous pyelography. Fistula was located using a cystoscope inserted through the vagina and placed over the fistula. The emitted light guides laparoscopic dissection into the plane between the vagina and the bladder just above the fistula, without previous intentional cystotomy. Results The mean age of patients was 42 (38–47) years. The bladder opening size did not reach 2 cm. The mean operative time was 160 (120–186) min and catheterization time was 10 days. There were no recurrences. Conclusions The laparoscopic repair of VVF without intentional cystotomy, by direct dissection of the fistulous tract guided by vaginal transillumination is effective, because it quickly locates the fistula in all cases, reduces the size of the bladder opening, shortens operative times and reduces irritative symptoms.