Latzko repair for vesicovaginal fistula revisited in the era of minimal-access surgery

Latzko repair is a technique described for repair of post-hysterectomy supratrigonal vesicovaginal fistulas (VVF) and is often practised by gynecologists, but it has not figured in the armamentarium of urologists the world over. Recently urologists have taken to laparoscopic repair of such fistula but laparoscopic repair is technically demanding with a steep learning curve. We reviewed our experience with the technique of Latzko repair. The study is a review of 10 patients operated by this technique between June 2000 and May 2005, with age ranging from 33 to 55 years (average 39 years). Fistula size ranged from 2 mm to 1 cm. There was no recurrence or sexual dysfunction due to shortening of vaginal length. The results were comparable with laparoscopic VVF repair in terms of morbidity, operative time, blood loss, and patient discomfort. Also, the learning curve involved is minimal. Thus this technique deserves wider adoption by the urological community and should be a benchmark for comparison with laparoscopic repair of VVF rather than the abdominal approach. Bearing in mind the simplicity of the procedure, urologists should feel encouraged to adopt this excellent age-old technique that has stood the test of time rather than exploring more-complex operations such as laparoscopic VVF repair and transurethral suture cystorrhaphy.