Laparoscopic repair of vesicovaginal fistula.
OBJECTIVE
Vesicovaginal fistula (VVF) is one of the most devastating surgical complications that can occur in women. The primary cause remains an abdominal hysterectomy. Approach to this condition can be transvaginal or transabdominal. Laparoscopic repair of VVF may be an alternative approach to this treating rare condition. We present seven cases of VVF treated with transperitoneal laparoscopic technique and our results.


METHODS
We retrospectively reviewed the charts of 7 women ranging from 37 to 74 years in age (mean age 52.8 years) at our institution who underwent laparoscopic transperitoneal repair of VVF between February 2004 and March 2006. Etiology of the VVF, surgical technique, operative time, length of hospital stay, and complications were reviewed.


RESULTS
Six of the seven VVFs we repaired laparoscopically resulted from gynecologic procedures, and one patient presented with a VVF after a ureterolithotripsy. Mean operative time ranged from 130 to 420 minutes (mean 280 minutes), and mean hospital stay was 7 days. In one patient conversion to open surgery was necessary due to prolonged operative time. Two complications occurred: a urinary tract infection in one patient and an inferior limb compartment syndrome in another.


CONCLUSIONS
Transvaginal laparoscopic repair of VVF is feasible and safe and provides excellent results. It is a good alternative to the abdominal approach. However, advanced laparoscopic skills are mandatory.
Otsuka
Rodrigo Artur Pereira
RA
Faculdade de Medicina de Botucatu-Universidade Estadual Paulista, Botucatu, Brazil.
Amaro
João Luiz
JL
Tanaka
Milton Tatsuo
MT
Epacagnan
Eduardo
E
Mendes
José Barbosa
JB
Kawano
Paulo Roberto
PR
Fugita
Oscar Eduardo Hidetoshi
OE
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000601:surgery*