Immediate Laparoscopic Nontransvesical Repair with Omental Interposition for Vesicovaginal Fistula Developing after Total Laparoscopic Hysterectomy

Video Objective To investigate the safety and feasibility of laparoscopic management for vesicovaginal fistula developing after TLH. Setting Case study, University hospital in Korea. Interventions A 51-year-old Korean woman underwent of immediate laparoscopic management for vesicovaginal fistula developing after total laparoscopic hysterectomy. A 51-year-old Korean woman was referred to my department for having urinary leakage two weeks before. She underwent total laparoscopic hysterectomy due to heavy vaginal bleeding and leiomyoma four weeks ago. We performed a laparoscopic vesicovaginal fistula repair with omental interposition on November 8th, 2016. We encountered a large adhesion from prior surgery in the pelvic cavity, so performed adhesiolysis using a harmonic sheers. After adhesiolysis, I performed bilateral ureterolysis that continued to the posterior bladder until it reaches the vesicovaginal space, which is then sharply dissected laterally and distally until the fistula is encountered. A bulb syringe were used to mobilize the vaginal cuff so that the dissection of the vesico-vaginal space and mobilization of the vagina could be performed easily. After adequate dissection and resection of the fistula tract from both the vagina and the bladder, a double-layer closure using 3-0 Vicryl was placed in a interrupted suture to secure the bladder. After the first layer of closure, the bladder was retrograde filled with 300cc of sterile water. Then second layer was closed in the same manner. And a single-layer closure of the vagina using a 1-0 Vicryl was placed transvaginally. After omental interposiotion to the fistula site, the procedure was over. There were no serious intraoperative or postoperative complications. Conclusion Laparoscopic approach for vesicovaginal fistula is safe and feasible.