Vesicovaginal fistula repair (vaginal, laparoscopic)
Vesicovaginal fistula (VVF) is an abnormal channel between bladder and vagina resulting in a urinary leakage. It is associated with gynaecologic procedures such as abdominal hysterectomy. Surgical repair remains the primary method of treatment after a failed attempt with conservative measures. Nowadays, several surgical procedures have been developed for VVF treatment depending on the etiology, location, severity, size of the fistula and experience of the surgeon. Laparoscopic repair of Vesicovaginal fistula has become the first-line approach because of its safety and effective minimally invasiveness.
First of all, A Foley catheter will be placed vaginally through the fistula and pulled out into the bladder guided by cystoscopy. A primary 10 mm port will be inserted at the umbilicus, and then set up the pneumoperitoneum routinely. Two other ports (5 and 10 mm) will be placed in the inferior abdominal wall. Then, the lateral peritoneum will be opened with endoscopic scissors and the vesico-vaginal space will be precisely developed until the bladder completely frees posteriorly from the vaginal wall and the catheter could be seen. After the removal of catheter, the fistulous tract and unhealthy tissue margins should be dissected carefully. Subsequently, the openings of the tract both on the bladder and vagina sides are sutured and closed with Vicryl. A suprapubic drain tube will be left in place and bladder drainage can be accomplished by an urinary indwelling of a Foley catheter.