Laparoscopic repair of vesicovaginal fistula

To describe a methodology for laparoscopic repair of vesicovaginal fistula (VVF), and to provide a comparison of results between a series of laparoscopic repairs, a series of transabdominal open repairs (TAORs), a series of transvaginal repairs (TVRs), and cases successfully managed without surgery.

A total of 16 patients were diagnosed with post-hysterectomy VVF. All patients were first managed conservatively with continuous drainage via a Foley catheter until dry. In 2 of the 16 cases (12.5%) the fistulae healed spontaneously with conservative management. After 4-12 weeks, the remaining 14 patients underwent surgical repair of their fistulas; 2 (14%) by laparoscopy, 6 (43%) by TAOR, and 6 (43%) by TVR.

Fistula repair was successful in both laparoscopy cases, all 6 TAOR cases, and 5 of 6 TVR cases (86%). The failed transvaginal repair was repeated, with a successful outcome. Length of hospital stay was 7-10 days (mean, 8.3 days) for the open cases, 3-5 days (mean, 4.1 days) for the transvaginal cases, and 2-12 days for the laparoscopic cases. One patient who underwent laparoscopic repair had a 12-day hospital stay due to extended vaginal drainage lasting 3 weeks, which then resolved. Three of the 6 patients who underwent TAOR (50%) experienced postoperative complications, including 2 cases of ileus and 1 case of fever. One of 6 patients who underwent TVR (16%) experienced recurrent urinary tract infection.

These data suggest that laparoscopic VVF repair is feasible and may result in lower morbidity, shorter hospital stay, and quicker recovery than the abdominal or transvaginal approaches. Additional controlled studies are warranted. The minimally invasive approach of laparoscopy may be a more attractive option for patients who experience VVF following hysterectomy.