Page 32 - World Journal of Laparoscopic Surgery

Minimal Access, Optimal Dryness: A Review of Laparoscopic Repair of Vesicovaginal Fistula
Study Selection and comparative studies have found the success rates between
Studies selected were original research articles published in the laparoscopic and open laparotomy to be comparable with a
last 10 years with >7 patients. Studies >10 years from the date of statistically significant shorter hospital stay and reduced blood
publication and/or studies with <8 patients were excluded. loss. 6,12,20
Previously, it was thought that the laparoscopic route may be
Data Extraction associated with a lot of conversions to open surgery, this review
The data assessed from the studies included: Success rate, mean has disproved that, as only 4 out of the 256 repairs were converted
blood loss, mean operating time, length of hospital stay, major to open surgery. Interestingly, conversions were not due to a
intraoperative complications, and conversion to open surgery. complication of laparoscopy per se but rather from dense intra-
abdominal adhesions/fibrosis (due to previous surgeries) which in
results itself is a relative contraindication to laparoscopy.
It was also thought that laparoscopic repair may not be suitable
Within the limits of the literature search, 14 full-text articles met the for patients with previously failed repair; however, this review has
aforementioned criteria. All articles were retrospective, there were revealed that the success rate for primary repair and those with
no prospective studies or randomized controlled trials. From this previously failed repairs are comparable.
review, a total of 269 patients underwent laparoscopic repair of VVF. With a complication rate of <1% from this review, credence
Two hundred and thirty-one (85.9%) cases were primary repairs, has been lent to the safety of the laparoscopic approach to VVF
while 38 (14.1%) cases had previous failed repairs. Nine out of the repair. The safety and minimal blood loss in laparoscopic repair
14 series reviewed reported a success rate of 100%, the other series may be attributed to the enhanced/magnified vision during surgery
reported success rates of 98, 95.5, 91.6, 87.5, and 86%, respectively. which affords the surgeon the benefit of dissecting tissues with a
Laparoscopic repair failed in only 9 out of the 269 patients (2 out high degree of precision and accuracy without iatrogenic injury
of these 9 patients were those with previously failed repair). The to adjacent structures. The pneumoperitoneum also functions as
pooled/overall success rate was 96.7%, while the success rates for a hemostatic tamponade to help minimize blood loss.
those undergoing primary and previously failed repair were 96.9 The quick recovery period, reduced hospital stay, and better
and 94.7%, respectively. Mean blood loss ranged from 30 to 400 cosmesis associated with laparoscopic repair have shown that
mL, length of hospital stay ranged from 1.1 to 7.8 days while the this approach confers on the patient some cost-benefit or
mean operating time ranged from 54 to 229 minutes. There was cost-utility.
only one major intraoperative complication (bleeding), giving a Laparoscopic repair of VVF is a highly technical and advanced
complication rate of 0.37%. Two hundred and sixty-five (98.5%) laparoscopic procedure which involves a lot of intracorporeal
cases were completed laparoscopically; only four patients had to suturing and knot tying, this underscores the need for proper
be converted to open surgery due to severe adhesions, the overall/ training and skill acquisition to attain expertise and competence
pooled conversion rate was 1.5% (Table 1). before it should be embarked upon. However, the advent of barbed
sutures, which eliminates the need for knot tying, can enhance
dIscussIon surgical efficiency and significantly shorten the operating time. 21
16
The first laparoscopic VVF repair was reported by Nezhat in 1994.
Like any advancement in medical practice, it was initially greeted conclusIon
with a lot of skepticism and criticism. However, over the years, The laparoscopic approach to the surgical management of VVF is
this approach has come to be embraced and has gained more effective, safe, and associated with minimal complications.
acceptance among fistula repair surgeons because of the available Fistula repair surgeons (particularly) in developing countries
evidence which has proved it to be very effective. Meta-analysis should acquire the necessary skills and acquaint themselves
Table 1: Outcome of laparoscopic vesicovaginal fistula repair
Mean blood Hospital Mean operating
Studies No. of patients Cure rate loss (mL) stay (days) time (minutes) Complication Conversion
Utrera et al. 7 8 100 No data 4.7 150 0 0
Abdel-Karim et al. 8 15 100 110 3.1 171.6 0 0
Miklos and Moore 9 44 98 39 1.1 144.8 0 0
Sharma et al. 10 22 100 75 5 140 0 0
Shuah 11 22 86 180 4.5 145 0 3
Xiong et al. 12 22 95.5 52 5.6 98.6 0 0
Chu et al. 13 11 100 229.4 No data 80.2 0 0
Abreu and Tanaka 14 8 87.5 No data No data No data 1 1
Javali et al. 15 22 100 35 1.5 75 0 0
Mallikarjuna et al. 16 20 100 30 2.5 54 0 0
Rizvi et al. 19 8 100 60 No data 145 0 0
Zhang et al. 18 18 100 95 5 135 0 0
González et al. 19 36 91.6 No data 7.8 140.4 0 0
Ghosh et al. 20 13 100 58.69 4 No data 0 0

World Journal of Laparoscopic Surgery, Volume 13 Issue 3 (September–December 2020) 131