Prospective Study on Clinical Outcomes of Laparoscopic Repair of Vesicovaginal Fistula with V-Loc 90 Suture

Abstract

1.1. Objective To study feasibility , efficacy and postoperative outcomes of laparoscopic vesicovaginal repair with barbed, resorbable 3-0 V-Loc 90 sutures. 1.2. Methods Patients presented with vesicovaginal fistula and failed with more than 3 weeks of bladder drainage using a foley catheter are selected for study. The cases where the fistula can be approached via vaginal route adequately without episiotomy or moderate to heavy traction, recurrent cases, complex fistulas , post radiation and malignant fistula are excluded from this study. 1.3. Results In our study from March 2019 to November 2021, total 15 patients were enlisted for laparoscopic VVF repair using V-Loc suture. The main objective of laparoscopic repair of VVF is rapid cessation of urinary leakage with early return of normal and complete urinary and genital function. The most common cause of VVF in our studies was hysterectomy 12 (80%), caesarean section 3 cases (20%) . In our study in all cases laparoscopic transperitoneal transvesical mini-O’ Conor approach with an interposition of omental graft or appendices epiploicae were adopted. In our study all fistulas were supratrigonal with average size of 1.8 cm (range 0.8 to 3.4 cm). Mean age of patients undergoing VVF repair was 39.9 years (range 26 to 48years) . Estimated blood loss was 63 ml (range 30 ml to 160 ml) , and mean operative time 130 minutes (range 100 to 190 minutes). There was no serious intraoperative or postoperative complications including: conversion to open procedure, denying operative procedure, vascular, bowel or ureteric injury, blood transfusion, blood clots, pulmonary embolism, cardiac events or strokes. Length of hospital stay was mean 5.2 days (range 3 to 8 days). Patients were instructed to return our outpatient department 14 to 21 days after surgery for cystogram, cystoscopic and vaginal inspection to confirm successful VVF repair and subsequent suprapubic catheter removal. At a mean of 14.7 months (range 6 to 37 months) no recurrence of VVF occurred with success rate is 100% (15 out of 15 patients). 1.4. Conclusions In the era of minimally invasive surgery, it is difficult to deny its role in the management of VVF. It can be performed safely and effectively with shorter operative time. It seems to offer patients a shorter hospital stay, less morbidity , quicker convalescence, better cosmesis and equal efficacy. Technically, laparoscopy provides better visualization through magnification, but is more difficult to learn, as is intracorporeal suturing. Use of resorbable continuous barbed sutures (V-Loc) simplify the technique and reduce the time of surgery while avoiding implementation of knots. Successful treatment using a laparoscopic approach in VVF is highly dependent on the surgeon’s experience, tissue conditions around fistulae, tension-free watertight closure, and adequate postoperative urinary drainage