Early Repair of Post-hysterectomy Vesicovaginal Fistulae Through a Laparoscopic Transperitoneal Extravesical Approach. Experience of a Single Center

To verify the feasibility and effectiveness of the correction of vesicovaginal fistulae (VVF) through a laparoscopic transperitoneal extravesical approach and TachoSil application as interposition tissue. VVF are the most common fistulae of the urinary tract and even today there is no agreement over the preferred approach to treat this kind of pathologic condition. We retrospectively analyzed the data of women who, from July 2010 to July 2017, underwent early laparoscopic transperitoneal extravesical VVF repair. Patients were placed in the lithotomy position. Five operating ports were placed. After the resection of the VVF, the vesical and vaginal edges were closed in two layers. Finally two layers of TachoSil (4 cm x 4 cm) were placed between the sutures. Several variables were considered in the perioperative period. Patients were re-evaluated at 1 and 3 months after surgery. Sixteen patients underwent VVF repair. Mean duration of the surgery was 106 minutes, mean length of stay was 3.2 days. No high grade complications according to Clavien–Dindo were reported. At 1 month all patients showed complete continence and at 3 months they reported a good quality of life. The laparoscopic approach described enables adequate repair of VVF. The use of Tachosil is straightforward and atraumatic, and may be considered as an alternative to tissue flap interposition. Finally, we confirm that the early approach is not a hazard in such a disabling disease and can be adopted to restore as soon as possible the good quality of life for patients.