Laparoscopic Management of Posthysterectomy Vesicovaginal Fistula

Video Objective To show our standardized method to surgically tackle posthysterectomy vesicovaginal fistulas by laparoscopy. Setting Universitary hospital, and reference center for gynecological diseases. Interventions We present two cases of posthysterectomy vesicovaginal fistulas referred to our hospital. Both had abdominal prior hysterectomies. We maintained Foley´s catheter 3 months prior to definitive surgery to avoid usual acute inflamation surrounding the fistula. We followed a very standardized method which consists of 5 steps: 1.- Anatomical survey / Adhesiolysis, 2.- Identification of vesicovaginal avascular space, 3.- Fistula identification, 4.- Further dissection of the vesico vaginal space, 5.- Individual vesical and vaginal defect closure. Conclusion Both patients were discharged 48 hours after surgery. Foley´s catheter was maintained for 14 days. We had performed such surgery in 6 consecutive cases with no fistula relapse.