Novel laparoscopic repair of VVF with limited cystotomy

ABSTRACT

Background: A Fistula is an extra anatomic communication between two or more epithelial lined body cavities or skin surface. Most of the vesicovaginal fistulas in industrialized and well developed countries are iatrogenic and most of the vesicovaginal fistulas in underdeveloped and developing countries are obstetric. Materials and methods: 10 cases of VVF presented to OGH OPD from October 2013 till September 2016 with age range 22 years to 43 years were included in study. Radiation fistulas, malignant fistulas, complex obstetric fistulas were excluded. Eight of the Ten cases were post hysterectomy (TAH) supra trigonal fistulas (7 single fistulas 1 case had two fistulas side by side), One case was post obstetric trigonal fistula, One case was post caesarean section where the fistula was in the anterior fornix close cervix. Results: Out of 10 patients, we had 1 port site infection, fever in 2 cases, increased drain for initial 2 days in 1 case. None of the 10 cases required blood transfusion, and there was no leak per vagina in all cases before and after catheter removal. All the patients were working patients, and resumed their work as early as 12 days after surgery. Conclusion: Conventional open repair with bivalving of bladder is associated with morbidity in the form of higher pain scores, higher HB % drop, prolonged hospitalization, prolonged catheterizations, and delayed resumption of work. Laparoscopic repair with limited cystotomy overcomes all the disadvantages of the conventional repair with equal results: