#1439

Innovative Approach in Laparoscopic Transvesical Repair of Vesicovaginal Fistulas: A Focus on T Cystostomy

D. YASASWINI¹, D. CHALUMURU¹, D. MYLARAPPA¹, D. T¹, D. KULKARNI¹, D. PUVVADA¹, D. JAVALI¹, D. DESIGOWDA¹

¹RAMAIAH MEDICAL COLLEGE, UROLOGY, BANGALORE, India

Introduction:

Surgical repairs of vesicovaginal fistulas (VVF) are most commonly performed: vaginally, abdominally, and laparoscopically. The approach to VVF repair is often dictated by the surgeon’s preference, location or complexity of the VVF. Here, we present our experience using a T cystotomy - laparoscopic transvesical approach technique to repair vesicovaginal fistulae and its outcomes .

Material and methods:

All patients undergoing laparoscopic VVF repair using a T cystotomy bladder incision were reviewed from January 2020 to September 2024. Those with supra trigonal fistula were included in our study and recurrent fistulas and post radiation fistulas were excluded. All patients underwent preoperative evaluation with CT urogram and ctystogram. Initial cystoscopy was performed to evaluate the fistula and assess the surrounding anatomy. Bilateral ureteric stents and a ureteric catheter were placed through the fistulous tract to facilitate surgical intervention and drainage. A limited midline posterior cystotomy was performed and extended downwards to include the fistula site in a T shape using ultrasonic energy. The fistula was dissected circumferentially to raise the bladder and vaginal flaps. The vaginal defect was closed in a transverse fashion and the cystotomy was closed vertically and horizontally.Intraoperative and post operative outcomes were assessed.

Results:

A total of 10 patients were incuded in the study.Mean operative time was 164±20 min and estimated blood loss was 54±9.5 ml. Omental Flap interposition was performed in all cases. No intraoperative complications were recorded. Mean hospital stay was 3.25±0.4 days. During hospitalization 1 patient experienced postoperative complications (Clavien grade I). Mean follow-up was 24.8±12.3 months (6.0–48.0 months). All patients remained continent during the follow-up period.None of the patients complained of overactivity and had adequate bladder capacity.