Laparoendoscopic single-site surgery extravesical repair of vesicovaginal fistula: early experience

Abstract

Objective: To describe for the first time the technique of laparoendoscopic single-site surgery (LESS) for repair of vesicovaginal fistula (VVF). LESS has recently been described as an alternative to conventional laparoscopy for the treatment of various urologic pathologic features.

Methods: The present study included 5 female patients with supratrigonal VVF who presented with urinary leakage per vagina after obstetric and gynecologic procedures. Extravesical LESS repair of VVF was done using the TriPort and prebent instruments. The fistulas tracts were identified and excised extravesically using sharp dissection. The edge of the bladder was trimmed at the site of fistula tract. The vagina was closed in 1 layer with continuous 3-0 Vicryl sutures, and the urinary bladder was closed in 2 layers using 3-0 Vicryl sutures. An additional 5-mm extraport was added at suturing to allow triangulation and hand-free extracorporeal suturing. An omental flap was interposed between the bladder and vagina. The urinary bladder was drained by an indwelling urethral catheter for 3 weeks.

Results: The operative time was 198±27.7 minutes. The blood loss was 90±25 mL. No intraoperative or postoperative complications developed. No conversion to conventional laparoscopy or open surgery was necessary. The postoperative hospital stay was 2 days. No postoperative urinary leakage occurred. The follow-up examination at 8±3.2 months showed complete continence and no recurrence of VVF.

Conclusion: LESS extravesical repair of VVF is a technically feasible and effective procedure that adheres to the principles of transabdominal open surgical repair. The technique has significant low morbidity; however, it requires advanced laparoscopic skills.