Page 31 - World Journal of Laparoscopic Surgery

REVIEW ARTICLE
Minimal Access, Optimal Dryness: A Review of Laparoscopic

Repair of Vesicovaginal Fistula

1
Michael S Archibong , Oluwole E Ayegbusi 2

AbstrAct
Background: Vesicovaginal fistula (VVF) is an embarrassing condition for women. Various routes of surgical intervention exist for the management
of VVF. Laparoscopic repair is safe and effective.
Aim and objective: To review the success rate of laparoscopic repair of VVF and to highlight the benefits/advantages of the laparoscopic approach.
Materials and methods: Using various databases, previous studies of patients who underwent laparoscopic VVF repair between 2008 and 2018
were reviewed. Outcome measures from these studies were success rate, mean blood loss, mean operating time, length of hospital stay, major
intraoperative complications, and conversion to open surgery.
Results: Fourteen retrospective studies (full-text articles) were retrieved and reviewed. Two hundred and sixty-nine patients had a laparoscopic
repair. The pooled success rate was 96.7%. Mean blood loss ranged from 30 to 400 mL, length of hospital stay ranged from 1.1 to 7.8 days while
the mean operating time ranged from 54 to 229 minutes. There was only one major intraoperative complication. Only four patients had to be
converted to open surgery.
Conclusion: Laparoscopic repair of VVF has a high success rate and is a safe, patient-friendly, and cost-effective route for surgical management
of VVF.
Keywords: Abdominal repair, Laparoscopic route, Vesicovaginal fistula.
World Journal of Laparoscopic Surgery (2020): 10.5005/jp-journals-10033-1416

IntroductIon 1,2 Department of Obstetrics and Gynaecology, Obafemi Awolowo
Vesicovaginal fistula (VVF) is an abnormal communication between University Teaching Hospital, ILE-IFE, Nigeria
the epithelium of the bladder and that of the vagina which leads to Corresponding Author: Michael S Archibong, Department of
continuous/total involuntary leakage of urine. It is a condition that Obstetrics and Gynaecology, Obafemi Awolowo University Teaching
not only affects the health of the woman but also imposes a great Hospital, ILE-IFE, Nigeria, Phone: +2348025997728, e-mail: beracah4@
deal of social embarrassment and psychological trauma on the yahoo.com
patient. It is considered as one of the most dehumanizing conditions How to cite this article: Archibong MS, Ayegbusi OE. Minimal Access,
that affect and reduce the quality of life of women. 1 Optimal Dryness: A Review of Laparoscopic Repair of Vesicovaginal
The etiology of VVF is largely influenced by socioeconomic Fistula. World J Lap Surg 2020;13(3):130–132.

development/standard of healthcare delivery system. In Source of support: Nil
underdeveloped/developing countries, prolonged labor accounts Conflict of interest: None
for over 90% of VVF; however, in developed countries, it is usually
from iatrogenic causes particularly from hysterectomies for
benign gynecological conditions, radiation therapy, and advanced becoming the norm and gold standard in gynecological practice
reproductive tract malignancies. 2 and diagnosis and treatment of various gynecological conditions
It has been estimated that there are about 3 million women including repair of VVF. Laparoscopic repair of VVF has been
with unrepaired fistula globally, with about 150,000 new cases conducted with remarkable success. 6
every year. 3 The purpose of this article is to review the success rates of the
Ever since the first successful VVF repair pioneered by James laparoscopic repair of VVF and also highlight some of the benefits/
Marion Sim, various methods and techniques have subsequently advantages of the laparoscopic repair.
been discovered and employed to surgically treat VVF. For the route
of repair, there is no consensus regarding the best route, as this is
influenced by various factors like the site, size, etiology, surgeons’ MAterIAls And Methods
choice, and level of expertise/competence. 4
Vesicovaginal fistula can be repaired by two routes: Vaginal Search Strategy
and abdominal. The abdominal route repair has been performed Relevant studies/publications were searched for using PubMed,
predominantly by open surgery (laparotomy) and is associated with Google Scholar, Cochrane library, ScienceDirect, Embase, and
more morbidities; these morbidities can be minimized/avoided via Medline. The databases were searched using the relevant medical
minimal access surgery. 5 subject headings (MeSH) terms. Search words included: vesico-
Minimal access surgery has reformed the field of gynecology; vaginal fistula, laparoscopic repair, abdominal route. No restriction
becoming established in everyday practice and is gradually was placed on the language of publication.

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