Laparoscopic Vesicovaginal Fistula Repair Using Kumar's Knotless Technique: Short-Term Experience From a Tertiary...

The laparoscopic (lap) technique is well-established for the repair of vesicovaginal fistula (VVF). However, its main limitation is a lack of expertise in intracorporeal suturing. This retrospective study presents a lap VVF repair using Kumar's knotless technique with V-Loc™ (Medtronic, MN, USA) barbed suture and compares its results with the open VVF repair technique.

In this retrospective study, we included 14 consecutive patients receiving VVF repair operated on by open conventional repair (open group) or lap knotless techniques (lap group) between March 2020 and March 2024. The data were recorded retrospectively.

Comparative analysis between the lap (n = 8) and open (n = 6) groups demonstrated that lap repair significantly reduced intraoperative blood loss (48.75 ± 15.00 mL vs. 108.33 ± 28.71 mL, respectively, p< 0.001), drain duration (3.13 ± 0.35 days vs. 7.17 ± 0.41 days, respectively, p< 0.001), postoperative pain (3.13 ± 1.55 vs. 6.17 ± 1.47, respectively, p < 0.01), and hospital stay (3.38 ± 0.74 days vs. 7.83 ± 0.98 days, respectively, p< 0.001). No significant differences were found between the lap and open groups in terms of mean age (33.25 ± 5.76 vs. 37.33 ± 5.77, respectively, p = 0.103), fistula size (1.56 ± 0.80 cm vs. 1.58 ± 0.37 cm, respectively, p = 0.938), or timing of bowel function return (15.25 ± 2.33 vs. 16.83 ± 3.71, respectively, p = 0.193). These results suggest that lap repair improves recovery outcomes without compromising clinical efficacy.

Lap VVF repair using Kumar's knotless technique with V-Loc™ barbed suture represents a feasible and safe approach to managing VVF. The technique offers a viable alternative to traditional methods, particularly in settings with limited experience with lap intracorporeal suturing and access to robotic surgery.