Vaginal repair of a complex supratrigonal vesicovaginal fistula

Vesicovaginal fistula (VVF) is one of the most common iatrogenic complications of pelvic surgery. Giant VVFs reported in the literature that were successfully repaired were done transabdominally or using a combination of different approaches. This study presents a giant VVF that was successfully repaired transvaginally. This is a case of a female who came in for continuous vaginal leakage which presented 3 weeks after a total hysterectomy. Physical examination revealed a 6.0×3.0 cm vaginal defect. The patient underwent Latzko repair of vesicovaginal fistula with peritoneal flap interposition. The patient had a successful repair and remained continent for 13 months on follow-up. Fistula size alone may not necessarily be a single determinant in the route of fistula repair. With surgical experience and other complex factors ruled out, successful vaginal repair of giant vesicovaginal fistulas proves to be possible.