title: Transperitoneal transvesical laparoscopic repair of vesicovaginal fistulae: experience of a tertiary care centre in northern India.
abstract: OBJECTIVE
  To present our experience of treating supratrigonal vesicovaginal fistulae by laparoscopic technique and their long-term follow-up.
  
  
  METHODS
  Between January 2008 and June 2012, 28 cases of supratrigonal fistulas were repaired by laparoscopic transperitoneal transvesical technique with interposition flap. The obstetric fistula was present in 18 and gynecologic fistula in 10 patients. Single supratrigonal fistula was present in 26 patients and in 2 patients there were 2 fistulae lying side to side. The vaginal opening was closed as single layer interrupted suture and cystotomy closed as single layer continuous suture by 3-0 polygalactin. The omentum was used as interposition flap in all except 2 cases in whom postero-superior vesical fold of peritoneum was used. The open conversion was required in 2 cases. The urethral catheter was removed in 4 weeks following a micturating cystogram.
  
  
  RESULTS
  The mean fistula size was 1.2 cm (range 0.8-2.5 cm). Open conversion was performed in 2 cases of whom one had excess carbon-dioxide retention and cardiac arrhythmia and in another case the needle of 3-0 polygalactin was avulsed and lost in peritoneal cavity which was recovered following laparotomy. All patients were continent following the catheter removal. The median follow-up is 24 months. None developed any complication related to laparoscopic repair till last follow-up.
  
  
  CONCLUSIONS
  Laparoscopic repair of supratrigonal vesicovaginal fistulae is an effective and safe minimally invasive treatment with excellent result.
authors.affiliation: Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Rahul J
authors.initials: RJ
authors.lastname: Sinha
authors.affiliation: Obstetrics & Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Seema
authors.initials: S
authors.lastname: Mehrotra
authors.affiliation: Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Dheeraj K
authors.initials: DK
authors.lastname: Gupta
authors.affiliation: Obstetrics & Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Smita
authors.initials: S
authors.lastname: Gupta
keywords: Laparoscopic surgery; Transperitoneal approach; Vesicovaginal fistulae