Introduction : Obstetric ﬁstula is a severe and debilitating condition occurring throughout the developing world. Although there are no accurate data on the incidence and prevalence of the condition, the majority of vesicovaginal fistulas develop after gynaecologic surgery, with transperitoneal hysterectomy accounting for 90% of cases. Several techniques are available for repairing the fistulas. Transperitoneal approaches give good results even for difficult posterior located fistulas, but are associated with increased morbidity compared with the transvaginal approach. We performed a laparoscopic repair and omentum interposition. Objective : To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Hasan Sadikin Hospital. Patient and Method : A 31-year-old female presented with vesicovaginal fistula after sectio caersaeran. After a failed trial of conservative treatment with catheter drainage, a transperitoneal laparoscopic repair was performed. Cystoscopy was performed initially to confirm the fistula location and for bilateral ureteric catheterization. A 4-port technique was performed with the patient in the position with her legs in lithotomy position. Without opening the bladder, the fistula tract was excised with separation of the bladder from the anterior vagina wall. Both the bladder and vagina walls were then closed separately using intracorporeal suturing with an interpositional omentum. Result : Total operative time was 270 min. Normal diet was resumed on day 1, drain was removed on post operatif day 1 and patient was discharged on the second day with an indwelling catheter. Good cosmetic result on wound operation and no leakage under cystogram after 2 weeks. The catheter was removed after 2 weeks. Conclusion : Laparoscopic transperitoneal repair of vesicovaginal fistula with omentum inteposition is feasible in Hasan Sadikin Hospital with good outcomes, short hospital days, and good cosmetics result. Keywords : Fistula vesico vaginal, laparoscopic.
Richman MB, Goldman HB. Vesicovaginal fistula : Abdominal approach. New York: Marcel Dekker; 2005.
Singh O, Gupta SS, Mathur RK. Urogenital fistulas in women: 5-year experience at a single center. Urology Journal. 2010;7:35-39
Audu BM, Kullima AA, Bako B. Epidemiology of vesico-vaginal fistula: No longer a calamity of teenagers. Journal Of Obstetrics And Gynaecology: The Journal Of The Institute Of Obstetrics And Gynaecology. 2008;28:432-433
Ou C-S, Huang UC, Tsuang M, Rowbotham R. Laparoscopic repair of vesicovaginal fistula. Journal Of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2004;14:17-21
Zarin M, Khan M, Afridi MR, Aurangzeb M. Transabdominal repair of vesicovaginal fistula: An experience of 27 cases. Pakistan Journal of Medical Sciences. 2010;26:581-584
Modi P, Goel R, Dodia S. Laparoscopic repair of vesicovaginal fistula. Urologia Internationalis. 2006;76:374-376
Ijaiya MA, Rahman AG, Aboyeji AP, Olatinwo AW, Esuga SA, Ogah OK, Raji HO, Adebara IO, Akintobi AO, Adeniran AS, Adewole AA. Vesicovaginal fistula: A review of nigerian experience. West African Journal Of Medicine. 2010;29:293-298
Sjøveian S, Vangen S, Mukwege D, Onsrud M. Surgical outcome of obstetric fistula: A retrospective analysis of 595 patients. Acta Obstetricia Et Gynecologica Scandinavica. 2011;90:753-760