Objective: To report our first experience in transperitoneal laparoscopic repair of vesicovaginal fistula in Dr. Hasan Sadikin Hospital.
Method: A 31-year-old female presented with vesicovaginal fistula
after cesarean section. Patient complained of urinary incontinence
since 5 years ago. After a failed trial of conservative treatment with
catheter drainage, a transperitoneal laparoscopic repair was performed.
Initially, cystoscopy was performed to confirm the fistula location
and for bilateral ureteric catheterization. A 4-port technique
was performed with the patient in lithotomy position and slightly
Trendelenburg. Without opening the bladder, the fistula tract was
excised and the bladder was separated from the anterior vaginal
wall. Both the bladder and vaginal walls were then closed separately
using intracorporeal suturing, interposed with the omentum.
Result: Total operative time was 270 minutes. Normal diet was resumed on day 1, drain was removed on the first day after surgery,
and the patient was discharged on the second day with an indwelling
catheter. Surgical wound showed good cosmetic result and no
leakage was identified from cystogram after 2 weeks. The catheter
was removed after 2 weeks.
Conclusion: Laparoscopic transperitoneal repair of vesicovaginal
fistula with omentum inteposition is feasible in Dr. Hasan Sadikin
Hospital with good outcome, short hospital stay, and good cosmetic
result.
[Indones J Obstet Gynecol 2014; 4: 223-225]
Keywords: laparoscopy, vesicovaginal fistula
Laparoscopic Transperitoneal and Retroperitoneal Nephrectomies in Children: A Change of Practice