Minimally Invasive Management of Vesicovaginal Fistulae: Laparoscopic Experience From a Teaching Hospital in Northeastern Mexico

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Introduction Vesicovaginal fistula (VVF) is an abnormal communication between the bladder and vagina that leads to continuous involuntary urine leakage and profoundly affects quality of life. In developed countries, most cases are iatrogenic, often following hysterectomy. Laparoscopic repair has emerged as a minimally invasive option with promising outcomes. This study aims to describe the experience of a tertiary referral center with laparoscopic repair of VVF. Methods A retrospective descriptive study was conducted at a university hospital in Monterrey, Mexico, between March 2023 and March 2025. Seven patients who underwent laparoscopic VVF repair were included. Preoperative evaluation involved clinical, imaging, and endoscopic assessment. All repairs were performed using the O'Conor technique with omental interposition. Perioperative variables and outcomes were analyzed. Results All VVFs were secondary to gynecological surgery (six abdominal hysterectomies and one vaginal hysterectomy). The mean patient age was 48 ± 6.2 years, with a BMI of 29.3 ± 3.8 kg/m². The mean time from hysterectomy to repair was 14.7 ± 8.6 months. Six fistulas were classified as simple and one as complex. Mean fistula size was 20 (15.0 - 20.0) mm, and 71.42% were supratrigonal. Mean operative time was 235.71 ± 155.52 minutes, with no conversions to open surgery. The average hospital stay was 2.7 ± 1.38 days, and Foley catheter removal occurred at 20.86 ± 3.53 days. No intraoperative or postoperative complications were observed, and no recurrences were noted during a mean follow-up of 2.57 ± 0.79 months. Conclusion Laparoscopic repair of VVF is a safe and effective surgical option, with favorable outcomes and minimal morbidity, particularly when standardized surgical principles are applied and omentum is used as an interpositional tissue. Further prospective studies are needed to define its role in broader clinical practice.

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