Category: Laparoscopy: Lower Tract - Benign

VS11-3 - A prospective evaluation of outcomes of 3-D transperitoneal laparoscopic vesico-vaginal fistula repair with omental interposition :Our experience

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

The vesicovaginal fistula(VVF) causes lot of morbidity to the women and is a very debilitating condition . The Laparoscopic VVF repair  is technically challenging,especially in trigonal fistula.We prospectively evaluated our experience of 3-D transperitoneal  laparoscopic VVF repair with omental interpositionin trigonal and supratrigonal VVF. 


Methods :

In this prospective study, all consecutive patients with trigonal and supratrigonal VVF ,from March 2014 to January 2018 ,requiring laparoscopic VVF repair with omental interposition were included.The patients with previous  failed VVF repair , post radiotherapy and VVF with malignancy were excluded from the study.The  various clinical data were recorded and analyzed. We are presenting video of one such case.


Results : A total of  31 patients were included in the study. The mean  age was 33.5 years .The fistula was post open abdominal hysterectomy in 13(42%) and post lower segment caesarean section(LSCS)  in 18(58%) patients.The mean fistula size was 2.6 cm .The fistula location was trigonal in 8(24.8%) and supratrigonal in 23(74.2%) patients.The mean operating time and mean estimated blood loss were 141.3 min and 71.37 ml respectively .Three(9.6%) patients required simultaneous modified Lich Gregoir ureteric reimplantation There was no open conversion and intraoperative complications.The mean catheterization  time ,mean hospital stay and mean convalescence were 10.9 days ,5.1 days and 2.1 weeks respectively.At mean follow up of 27.9months ,postoperative complications were mainly clavien 1 and 2 in only 4(12.9%) patients .None of the patients  showed  recurrence of VVF or voiding symptoms .


Conclusions :

3-D transperitoneal  laparoscopic VVF repair with omental interpositionin trigonal and supratrigonal VVF is feasible,safe with excellent long term efficacy.However,it is a technically challenging procedure and should be done by surgeons of significant laparoscopic expertise. 

Anup Kumar

Professor and Head
Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi
Delhi, Delhi, India

Niraj Kumar

Assistant Professor
Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi
Delhi, Delhi, India

Pawan Vasudeva

Professor
Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi
Delhi, Delhi, India

Siddharth Yadav

Assistant Professor
Department of Urology and Renal transplant , VMMC and Safdarjang Hospital ,New Delhi
Delhi, Delhi, India

Sandeep Kumar

Assistant Professor
Department of Urology and Renal Transplant ,VMMC and Safdarjang Hospital,New Delhi,India
Delhi, Delhi, India

Pankaj Gupta

Senior resident
Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
Delhi, Delhi, India

Saurav Kumar

Senior Resident
Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
Delhi, Delhi, India

Vishnu Prasad

Senior Resident
Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
Delhi, Delhi, India

Y m Prashant

Senior Resident
Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
Delhi, Delhi, India

Vijay Tyagi

senior Resident
Department of Urology and Renal Transplant, VMMC and Safdarjang Hospital, New Delhi, India
Delhi, Delhi, India