Otsuka Rodrigo Artur Pereira, Amaro João Luiz, Tanaka Milton Tatsuo, Epacagnan Eduardo, Mendes José Barbosa, Kawano Paulo Roberto, Fugita Oscar Eduardo Hidetoshi
Faculdade de Medicina de Botucatu-Universidade Estadual Paulista, Botucatu, Brazil.
J Endourol. 2008 Mar;22(3):525-7. doi: 10.1089/end.2006.9846.
Vesicovaginal fistula (VVF) is one of the most devastating surgical complications that can occur in women. The primary cause remains an abdominal hysterectomy. Approach to this condition can be transvaginal or transabdominal. Laparoscopic repair of VVF may be an alternative approach to this treating rare condition. We present seven cases of VVF treated with transperitoneal laparoscopic technique and our results.
We retrospectively reviewed the charts of 7 women ranging from 37 to 74 years in age (mean age 52.8 years) at our institution who underwent laparoscopic transperitoneal repair of VVF between February 2004 and March 2006. Etiology of the VVF, surgical technique, operative time, length of hospital stay, and complications were reviewed.
Six of the seven VVFs we repaired laparoscopically resulted from gynecologic procedures, and one patient presented with a VVF after a ureterolithotripsy. Mean operative time ranged from 130 to 420 minutes (mean 280 minutes), and mean hospital stay was 7 days. In one patient conversion to open surgery was necessary due to prolonged operative time. Two complications occurred: a urinary tract infection in one patient and an inferior limb compartment syndrome in another.
Transvaginal laparoscopic repair of VVF is feasible and safe and provides excellent results. It is a good alternative to the abdominal approach. However, advanced laparoscopic skills are mandatory.
膀胱阴道瘘（VVF）是女性可能发生的最具破坏性的手术并发症之一。主要病因仍是腹部子宫切除术。治疗这种疾病的方法可以是经阴道或经腹的。腹腔镜修复膀胱阴道瘘可能是治疗这种罕见疾病的一种替代方法。我们介绍7例采用经腹腹腔镜技术治疗的膀胱阴道瘘病例及我们的结果。
我们回顾性分析了2004年2月至2006年3月在我院接受腹腔镜经腹修复膀胱阴道瘘的7名年龄在37至74岁（平均年龄52.8岁）女性的病历。对膀胱阴道瘘的病因、手术技术、手术时间、住院时间和并发症进行了回顾。
我们腹腔镜修复的7例膀胱阴道瘘中有6例源于妇科手术，1例患者在输尿管碎石术后出现膀胱阴道瘘。平均手术时间为130至420分钟（平均280分钟），平均住院时间为7天。1例患者因手术时间延长而需要转为开放手术。发生了2例并发症：1例患者发生尿路感染，另1例患者发生下肢筋膜室综合征。
经阴道腹腔镜修复膀胱阴道瘘是可行且安全的，并能取得良好效果。它是腹部手术方法的一个很好的替代方案。然而，必须具备先进的腹腔镜技术。
