[2026-01-26] Laparoscopic Vesicovaginal Fistula Repair: 2 Cases From Chaophrayayommarat Hospital

Abstract

Background: Vesicovaginal fistula (VVF) is a distressing complication most commonly resulting from gynecologic surgeries, particularly abdominal hysterectomy. Laparoscopic repair offers a minimally invasive alternative to open surgery, providing favorable outcomes and quicker recovery.

Case Presentation: This report presented 2 cases of posthysterectomy VVF managed at a provincial hospital. The first case was a 39-year-old woman who developed persistent urinary leakage one month after abdominal hysterectomy. Imaging revealed a 3-mm fistula near the left ureteric orifice, and cystoscopy showed a 1 cm defect. The second case was a 45-year-old woman who presented with leakage 16 months posthysterectomy and intraoperative bladder repair. Imaging and cystoscopy confirmed a 6-mm midline fistula. Both patients underwent laparoscopic transabdominal VVF repair using the O’Conor technique. Key surgical steps included cystotomy, layered closure with nonoverlapping sutures, and omental interposition. Ureteral stenting was used to prevent injury, and Foley catheters were left for 2 weeks postoperatively. Both surgeries were completed successfully without major complications. Operative times were approximately 4 hours. Blood loss was minimal. Patients were discharged within 3-5 days, and followed-up at 1, 3, and 6 months which confirmed complete continence and improved quality of life.

Conclusions: Laparoscopic VVF repair is a feasible technique to minimize postoperative pain and length of hospital stay, as well as enhance access to quality of care and reduce the burden of referral to tertiary centers.