Laparoscopic repair of vesico-vaginal fistula without intentional cystotomy and guided by vaginal transillumination

ObjectivesRepair of vesico-vaginal fistula (VVF) by laparoscopy provides excellent exposure, which facilitates their implementation through small cystotomy. In some cases is difficult to locate the fistula without the prior opening of the bladder. We present a maneuver using vaginal transillumination to locate the fistula and to reduce the size of the opening bladder during laparoscopic repair without intentional cystotomy.Material and methodsA total of 4 patients with supra-trigonal FVV produced post-hysterectomy received laparoscopic repair. All patients underwent physical examination, dye test, urethrocystoscopy and intravenous pyelography. Fistula was located using a cystoscope inserted through vagina and placed over the fistula. The emitted light guide laparoscopic dissection in to the plane between the vagina and the bladder just above the fistula, without previous intentional cystotomy.ResultsThe mean age of patients was 42 (38-47) years. Bladder opening size did not reach 2 cm. The mean operative time was 160 (120-186) minutes and catheterization time was 10 days. There were no recurrences.ConclusionsThe laparoscopic repair of VVF without intentional cystotomy, by direct dissection of the fistulous tract guided by vaginal transillumination is effective; because it quickly locates the fistula in all cases, reduces the size of the bladder opening, shortens operative times and reduces irritative symptoms.