title: Laparoscopic treatment of vesicovaginal fistula.
abstract: BACKGROUND
  Vesicovaginal fistula is a rare disease with great impact for the patients. Laparoscopic repair can be an interesting option in selected cases with goods results but few experience is reported.
  
  
  OBJECTIVE
  Detailed demonstration of our laparoscopic vesicovaginal fistula repair technique. Initial results for ten patients are provided Methods: We treated all cases by the same technique. The surgical steps were: Patient positioning in Lloyd-Davis; Cystoscopy and implant of guide wire on fistula and ureteral catheters (that was removed after procedure); Transperitoneal access and 4 or 5 ports in V or W shape; Opening the bladder wall; Dissection between bladder and vagina for tension free repair; Fistula resection; Vagina repair with Vicryl 3-0; Bladder repair with Vicryl 3-0; Peritoneum/omentum interposition; Positioning 20 Fr urethral catheter.
  
  
  RESULTS
  Mean age was 50 years. Mean number of fistulas was 1,2. The most common etiology was gynecologic surgery (7). Mean operative time was 2,5 (1,8-3,2) hours. Mean blood loss was 150 (100-200)mL. Complication rate was 10% (one case of urinary infection treated conservatively). Mean hospital stay was 1,2 (1-2) days. Mean return to normal and activities was 20 (15-30) days. For nine patients mean sexual intercourse time was 3 (1-6) months. Success rate after 1 year was 90% (one case of recurrence in patient with previous radiotherapy). Mean follow-up was 36 (12-60) months.
  
  
  CONCLUSIONS
  Laparoscopic repair is feasible, reproducible and present all advantages of minimally invasive surgical procedure. Long term results are similar to conventional open approaches.
authors.affiliation: Section of minimally invasive surgery, Departament of urology, ABC Medical School, Santo Andre, Sao Paulo, Brazil.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tobias-Machado
authors.affiliation: Section of minimally invasive surgery, Departament of urology, ABC Medical School, Santo Andre, Sao Paulo, Brazil.
authors.forename: Pablo Aloisio Lima
authors.initials: PA
authors.lastname: Mattos
authors.affiliation: Section of Minimally Invasive Surgery, Mater Dei Hospital, Belo Horizonte, MG, Brazil.
authors.forename: Pedro Romanelli de
authors.initials: PR
authors.lastname: Castro
authors.affiliation: Department of Urology, Minas Gerais Hospital Foundation, MG, Brazil.
authors.forename: Ricardo Hissashi
authors.initials: RH
authors.lastname: Nishimoto
authors.affiliation: Section of minimally invasive surgery, Departament of urology, ABC Medical School, Santo Andre, Sao Paulo, Brazil.
authors.forename: Antonio Carlos Lima
authors.initials: AC
authors.lastname: Pompeo
mesh_terms: D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000601:surgery*