title: Laparoscopic repair of vesicovaginal fistula.
abstract: OBJECTIVE
  Vesicovaginal fistula may be a complication of urogynecologic surgery. We describe the technique of laparoscopic repair of vesicovaginal fistula as performed at our 2 institutions.
  
  
  METHODS
  Since August 1998 laparoscopic repair of vesicovaginal fistula was performed in 15 select patients who had clear indications to undergo surgical treatment through an abdominal approach. Hysterectomy had previously been performed in 14 patients (93%). Conservative treatment was initially attempted for more than 2 months in all cases. Four patients had undergone a previous surgical fistula closure attempt with unsuccessful results. Our technique involved cystoscopy, catheterization of the vesicovaginal fistula, laparoscopic cystotomy, opening and excision of the fistulous tract, dissection of the bladder from the vagina, cystotomy closure and colpotomy with interposition of a flap of healthy tissue. Demographic as well as perioperative and outcome data were recorded.
  
  
  RESULTS
  Average patient age was 38 years. None of the cases required open conversion. Mean operative time was 170 minutes (range 140 to 240). Mean hospital stay was 3 days (range 2 to 5). The mean duration of bladder catheterization was 10.4 days (range 9 to 15) At a mean followup of 26.2 months (range 3 to 60) 14 patients (93%) were cured.
  
  
  CONCLUSIONS
  We believe that laparoscopic repair of vesicovaginal fistula is a feasible and efficacious minimally invasive approach for the management of this entity.
authors.affiliation: Section of Laparoscopic and Minimally Invasive Surgery, Department of Urology, La Floresta Medical Institute, Caracas, Venezuela.
authors.forename: René
authors.initials: R
authors.lastname: Sotelo
authors.forename: Mirandolino B
authors.initials: MB
authors.lastname: Mariano
authors.forename: Alejandro
authors.initials: A
authors.lastname: García-Segui
authors.forename: Rinci
authors.initials: R
authors.lastname: Dubois
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Spaliviero
authors.forename: Wartan
authors.initials: W
authors.lastname: Keklikian
authors.forename: John
authors.initials: J
authors.lastname: Novoa
authors.forename: Henry
authors.initials: H
authors.lastname: Yaime
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D013520:Urologic Surgical Procedures / Q000379:methods; D014719:Vesicovaginal Fistula / Q000601:surgery*