Minimally invasive approaches to vesico-vaginal fistula repair include both vaginal and laparoscopic techniques. When the fistula is located in an accessible portion of the vagina and the risk of recurrence is low, a vaginal repair may be appropriate. When the fistula is located in an inaccessible portion of the vagina, or if excision of the tract and/or interposition of a layer between the bladder and vagina is desired, a laparoscopic approach may be appropriate. This video compares the two techniques.

The first section of the video shows the repair of a small vesico-vaginal fistula in an accessible portion of the vagina via a vaginal technique. A pediatric feeding tube is inserted into the fistula for traction. Stay sutures are placed lateral to the fistula, and the vaginal epithelium is undermined. The fistula tract is then closed with a purse-string suture and inverted. The epithelium is then closed. The tract is not excised and no tissue or material is interposed between the suture lines.

The second section of the video shows the laparoscopic repair of a larger fistula located high in the vagina of a patient without uterine descent. The bladder is dissected away from the cervix and upper vagina and opened. The fistula tract is identified and excised. The bladder wall is separated from the vagina and closed in two layers. The vaginal defect is repaired in a single layer and an  absorbable adhesion barrier is placed between the two suture lines.

Catheters were removed after 7 days and both patients had complete resolution of symptoms. Neither fistula has recurred.

Both vaginal and laparoscopic repairs are feasible for vesico-vaginal fistula, and the choice of technique may be driven by patient factors and surgeon experience.

Continence 2S2 (2022) 100393
DOI: 10.1016/j.cont.2022.100393