LAPAROSCOPIC REPAIR OF VESICO-VAGINAL FISTULA WITHOUT BLADDER BIPARTICION
J. B. Mendes1, M. T. Tanaka1, M. J. B. C. Giron2, O. E. H. Fugita3, j. l. Amaro3, E. F. Pacagnan1, M. R. S. S. B. Mendes, A. S. Tanaka1
1Master Clínica, Cascavel, Brazil, 2Unesp São Paulo, Brazil, 3Unesp, Botucatu, Brazil, 4Unioeste, Cascavel, Brazil
Introduction: Laparoscopic approach to treat patients with pacients with high vesico-vaginal fistula has been successfully reported, and in the majority of them, using a technique that includes bladder bipartition.
Method: A 36-year-old patient, with a 7 to 8 mm wide fistula, between the supra trigone bladder region and the vaginal vault, had an 8-week waiting time before transperitoneal laparoscopic repair by a simplified technique avoiding bladder bipartition. This fistula was secondary to a recurrent endomethrioma resection in the vaginal vault, with prior hysterectomy. The patient was positioned at a Trendelenburg with the vagina being easily accessible, using no fistula ou ureter catetherization. The vaginal vault was kept distended by a gauze wad, and vesical orifices were closed by interrupted 3-0 Vicryl sutures. In order to minimize recurrence risk, a pediculated omental flap was interposed between the sutured orifices. An indwelling Foley catheter was left for 10 days in the bladder.
Result: The total operation time was 130 minutes. The patient had minimal pain complaint, with no relevant blood loss and was discharged at the third post operative day. There were no complications and after the Foley removal no fistula recurrence occurred. The major difficulty was the lyses of bowel adhesions at the fistula region.
Conclusion: The laparoscopy may be a good treatment option for fistula repair, since it allows a less aggressive approach, while permitting the surgeon to perform reliable posterior bladder suturing without bipartition.