Vesicovaginal fistulas (VVFs) are distressing complications, most commonly resulting from gynecologic surgery such as hysterectomy. While traditional transvaginal or transabdominal approaches remain standard, certain fistula locations—particularly supratrigonal or those near the ureteric orifices—present challenges to access and repair. We hypothesized that a minimally invasive pneumovesical approach using laparoscopic intravesical access could provide a safe and effective alternative for selected VVF cases.

This retrospective, single-center study reviewed 26 cases of laparoscopic pneumovesical VVF repair performed between 2013 and 2023. All patients had a history of prior gynecologic surgery and fistulas confirmed by cystoscopy and CT urogram. The procedure utilized three 5 mm laparoscopic ports inserted directly into the bladder wall under cystoscopic guidance, with CO₂ insufflation to create a pneumovesicum. The vaginal and bladder layers were repaired intracorporeally using 4-0 Vicryl sutures. Operative outcomes, complications, and recurrence rates were analyzed. CUSUM (cumulative sum) analysis was used to evaluate the learning curve.

Out of 26 patients, 23 (88.5%) had successful primary repair. Two cases required reoperation, both of which were successfully treated using the same approach. One patient required conversion to open surgery due to insufficient bladder capacity and large fistula size. Mean operative time was 99.9 minutes, with minimal blood loss and no transfusions. The average catheterization time was 11 days, and no cases of long-term urinary leakage were observed. Minor complications (e.g., hematuria, UTI) occurred in 30.8% of patients (Clavien-Dindo grade I–II). CUSUM analysis indicated a learning curve extending to the 19th case.

The pneumovesical approach offers a direct, minimally invasive route for supratrigonal VVF repair with favorable outcomes and a short recovery period. Its efficacy is particularly notable in patients with a history of radiation or complex anatomy that limits access via vaginal or abdominal routes.

Laparoscopic pneumovesical VVF repair is a safe and effective alternative to traditional methods for select patients, with a high success rate and low morbidity. This technique may be especially valuable in challenging anatomical settings and can be considered a viable first-line surgical option for supratrigonal fistulas.