Journal of the European Society for Gynaecological Endoscopy


Early approach for the iatrogenic vesico-vaginal fistula repair: a video case report

M. Afonina1,2, S. Waligora Lages2,3, A. Liori2,4, R. Botchorishvili2

1 San Paolo University Hospital, Department of Obstetrics and Gynaecology, Via Antonio di Rudinì, 8, 20133, Milan, Italy
2 Department of Gynaecological Surgery, CHU Estaing Clermont-Ferrand, 1 Place Lucie Aubrac, 63000 Clermont-Ferrand, France
3 Hospital Israelita Albert Einstein, Department of Obstetrics and Gynaecology, Avenida Albert Einstein, 627|701, Morumbi – Sao Paulo, Brazil
4 General Maternal Hospital of Elena Venizelou, Elena Venizelou 2, Athens 11521, Greece


Vesico-vaginal fistula; early repair; minimally invasive approach

Published online: Jun 28 2024


Background: Vesico-vaginal fistula (VVF) is a rare but debilitating condition, characterised by an abnormal connection between the bladder and vagina. While obstetric-related cases prevail in developing countries, iatrogenic fistulas are more common in industrialised ones, often resulting from pelvic surgeries.

Objectives: The optimal timing for surgical correction of VVF remains debated, often leaning towards delayed intervention. Here we report a successful early laparoscopic repair of an iatrogenic VVF following hysterectomy.

Materials and Methods: The patient, a 54-year-old woman, presented with VVF after a hysterectomy. The laparoscopic repair was performed promptly upon diagnosis.

Main outcome measures: To assess the feasibility and effectiveness of an early repair of a gynaecological-related VVF.

Results: First, cystoscopy identified the bladder edge of the VVF. Second, laparoscopy was performed and the vesico-vaginal dissection was carried out. The excision of the previous stitches and of the fibrotic tissue was undertaken to create free flaps for suturing. The bladder was repaired in a double layer, and a single layer was applied to the vagina. Finally, the omentoplasty was done. The patient was discharged on postoperative day 5. No complications occurred.

Conclusions: This successful case demonstrates the feasibility and safety of early laparoscopic repair for gynaecological surgery-related vesico-vaginal fistulae. While acknowledging the need for further studies to standardise techniques, this report contributes to the evolving understanding of optimal management for this complex condition.

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