Transvaginal repair of vesicovaginal fistula using a peritoneal flap

Even complex vesicovaginal fistulas may be repaired transvaginally. In difficult repairs adjunctive measures have been described to increase the success rate of surgery, including Martius flaps, labial flaps or gracilis muscle flap. We describe a new technique to repair difficult vesicovaginal fistulas via a transvaginal approach. A flap of peritoneum is developed and used to buttress the fistula repair. This repair was successful in 9 of 11 patients (82%). Complications occurred in only 1 patient who suffered a bladder diverticulum containing a stone. The major advantage of this technique is its simplicity and lack of an extravaginal harvesting incision. This repair is particularly well suited for complex, high lying vesicovaginal fistulas.