The vesicovaginal fistula (VVF) causes lot of morbidity to the women and is a very debilitating condition. The Laparoscopic VVF repair is technically challenging, especially in trigonal fistula. We prospectively evaluatedour experience of 3-D transperitoneal laparoscopic VVF repair with omental interposition in trigonal and supratrigonal VVF.
In this prospective study, all consecutive patients with trigonal and supratrigonal VVF, from March 2014 to January 2018, requiring laparoscopic VVF repair with omental interposition were included. The patients with previous failed VVF repair, post radiotherapy and VVF with malignancy were excluded from the study. The various clinical data were recorded and analyzed. We are presenting video of one such case.
A total of 31 patients were included in the study. The mean age was 33.5 years. The fistula was post open abdominal hysterectomy in 13 (42%) and post lower segment caesarean section (LSCS) in 18 (58%) patients. The mean fistula size was 2.6 cm. The fistula location was trigonal in 8 (24.8%) and supratrigonal in 23 (74.2%) patients. The mean operating time and mean estimated blood loss were 141.3 min and 71.37 ml respectively. Three(9.6%) patients required simultaneous modified Lich Gregoir ureteric reimplantation. There was no open conversion and intraoperative complications. The mean catheterization time, mean hospital stay and mean convalescence were 10.9 days, 5.1 days and 2.1 weeks respectively. At mean follow up of 27.9 months, postoperative complications were mainly Clavien 1 and 2 in only 4 (12.9%) patients. None of the patients showed recurrence of VVF or voiding symptoms.
3-D transperitoneal laparoscopic VVF repair with omental interpositionin trigonal and supratrigonal VVF is feasible, safe with excellent long term efficacy. However, it is a technically challenging procedure and should be done by surgeons of significant laparoscopic expertise.