title: A simplified laparoscopic approach to repair vesicovaginal fistula: the M.S. Ramaiah technique.
abstract: OBJECTIVE
  To describe a simplified laparoscopic approach for the management of vesicovaginal fistula (VVF), with the specific aim of decreasing laparoscopic intracorporeal suturing and to highlight our results with this simplified approach.
  
  
  METHODS
  A retrospective chart review was carried out to all patients who underwent VVF repair at our institute by the "simplified laparoscopic approach" between January 2011 and August 2014. Preoperative evaluation consisted of intravenous urography, micturating cystography, and cystoscopy. Patients with malignant fistulas, history of pelvic irradiation, or co-existent ureteric fistulas were excluded. The procedure consisted of an initial cystoscopy to intubate bilateral ureteric orifices with ureteric catheter, as well as the fistula with a ureteric catheter of different color. A 3-port technique was used. The simplified laparoscopic approach consisted of limited cystotomy, single-layer bladder closure with 3-0 V-Loc barbed suture and omental patch over the vaginal opening.
  
  
  RESULTS
  A total of 22 patients were included in the analysis. Mean interval before surgery was 2.5 months. One patient had previous failed transvaginal repair. Transvaginal hysterectomy for benign uterine pathology constituted the predominant etiology of VVF in this series. Mean fistula size was 7 mm. Mean operative time was 75 minutes. All patients were continent at catheter removal at postoperative day 14 and remained symptom free in the follow-up period.
  
  
  CONCLUSIONS
  The simplified laparoscopic approach of VVF repair produces excellent results with minimal morbidity.
authors.affiliation: Department of Urology, M.S. Ramaiah Hospital, Bangalore, India. Electronic address: tarunjavali@gmail.com.
authors.forename: Tarun Dilip
authors.initials: TD
authors.lastname: Javali
authors.affiliation: Department of Urology, M.S. Ramaiah Hospital, Bangalore, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Katti
authors.affiliation: Department of Urology, M.S. Ramaiah Hospital, Bangalore, India.
authors.forename: Harohalli K
authors.initials: HK
authors.lastname: Nagaraj
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D013520:Urologic Surgical Procedures / Q000379:methods; D014719:Vesicovaginal Fistula / Q000601:surgery*