Wong Carson, Lam Po N, Lucente Vincent R
Department of Urology, The University of Oklahoma, Oklahoma City 73104, USA.
J Endourol. 2006 Apr;20(4):240-3; discussion 243. doi: 10.1089/end.2006.20.240.
Transabdominal transvesical repair has been the standard treatment for difficult vesicovaginal fistulae. We describe a laparoscopic transvesical technique that minimizes operative morbidity while adhering to the principles of transabdominal repair as described by O'Conner.
The patient is placed in the lithotomy position using Allen stirrups, and bilateral 5F open-ended ureteral catheters are placed cystoscopically. Using four laparoscopic ports, the prevesical space is accessed. The bladder is bivalved down to the fistula, and stay sutures are placed at the bladder edges for exposure. The fistulous tract and adjacent fibrotic tissue are excised, and the bladder and vagina are closed separately with single layers of full-thickness interrupted 2-0 Vicryl sutures. An omental flap is interposed between suture lines in the bladder and vagina. The ureteral catheters are sequentially removed on the first and second postoperative days. A gravity cystogram is performed 3 weeks postoperatively; if it is normal, the urethral catheter is removed.
This procedure has been performed on two consecutive patients who had failed prior Latzko repairs. Both patients were discharged 2 days postoperatively without complications. At a follow-up of 41 months in the first patient and 39 months in the second, no fistula recurrence has been seen.
Laparoscopic transvesical vesicovaginal fistula repair appears to be a safe and effective procedure that adheres to the principles of a transabdominal transvesical fistula repair while decreasing morbidity and improving cosmesis. Continued follow-up is required to determine its long-term efficacy compared with the accepted open transabdominal and transvaginal approaches.
经腹经膀胱修补术一直是治疗复杂性膀胱阴道瘘的标准术式。我们描述一种腹腔镜经膀胱技术，该技术在遵循奥康纳所描述的经腹修补原则的同时，将手术并发症降至最低。
患者使用艾伦氏马镫置于截石位，经膀胱镜置入双侧5F开放式输尿管导管。通过四个腹腔镜端口进入膀胱前间隙。将膀胱沿瘘口纵行切开，在膀胱边缘放置牵引缝线以利于暴露。切除瘘管及其周围的纤维化组织，分别用单层全层间断2-0薇乔缝线关闭膀胱和阴道。在膀胱和阴道的缝线之间置入大网膜瓣。术后第1天和第2天依次拔除输尿管导管。术后3周行重力膀胱造影；如果结果正常，则拔除尿道导管。
该手术连续应用于2例先前Latzko修补术失败的患者。两名患者均于术后2天出院，无并发症发生。首例患者随访41个月，第二例患者随访39个月，均未见瘘管复发。
腹腔镜经膀胱膀胱阴道瘘修补术似乎是一种安全有效的手术，它遵循经腹经膀胱瘘修补术的原则，同时降低了并发症发生率并改善了美观效果。与公认的开放经腹和经阴道手术方法相比，需要持续随访以确定其长期疗效。
