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The AINU Technique for Laparoscopic Vesico-Vaginal Fistula Repair: A Preliminary Report
Chiuruvella Mallikarjuna1, Prasant Nayak, K Purnachandra C Reddy
1Asian Institute of Nephrology and Urology (AINU), Hyderabad, India.
Introduction:
With safe obstetric practices now globally available, most vesico-vaginal fistulas (VVF) presenting in recent times are secondary to various gynecologic surgeries. Most of them are supra-trigonal in location. Laparoscopic repair of VVF is gaining ground as an alternative to open repair of VVF. In this study, we describe our initial experience with a novel technique of laparoscopic VVF repair involving a limited transverse cystotomy for access and a single-layered barbed suture closure of bladder.
Materials And Methods:
Twenty cases of supra-trigonal VVFs following gynecologic surgeries were taken up for repair by our novel technique. The mean age of the patients was 32 years and the mean VVF size was 1.5 cm.
Results:
The mean operative time was 54 min. Estimated mean blood loss was 30 ml and the mean postoperative stay was 2.5 days. None of the patients had any recurrence with a mean follow-up of 14 months.
Conclusion:
The limited transverse cystotomy approach has advantages in decreasing the operative time, improving ease of laparoscopic suturing, allowing an automatic separation of suture lines and allowing for an easier anterior dissection of the bladder to reduce tension on the suture line if necessary. Further this approach provides excellent results in select patients of supra-trigonal VVF in terms of continence and postoperative bladder overactivity.
