Giannakopoulos Stilianos, Arif Halil, Nastos Zisis, Liapis Apostolos, Kalaitzis Christos, Touloupidis Stavros
Department of Urology, Democritus University of Thrace, Alexandroupolis, Greece.
Endoscopy Unit, Democritus University of Thrace, Alexandroupolis, Greece.
Asian J Urol. 2020 Oct;7(4):351-356. doi: 10.1016/j.ajur.2019.04.004. Epub 2019 Jul 8.
Two conventional approaches for vesicovaginal fistula (VVF) repair are transabdominal repair for supratrigonal VVF and transvaginal approach for low lying fistulae. Laparoscopic surgery was introduced to duplicate the surgical steps of the transabdominal approach with reduction in morbidity. We report a series of patients treated with a modified laparoscopic technique which includes the use of only three trocars and a limited posterior cystotomy.
We retrospectively reviewed the data of eight patients who underwent laparoscopic VVF repair with our standardized technique from January 2015 to April 2018. Only cases with a supratrigonal fistula were included. We constantly used only three trocars. A limited 2 cm midline posterior cystotomy was performed using ultrasonic energy. A stay suture on a straight needle was passed percutaneously in the abdomen, then on either side of the cystotomy and finally was exteriorized to maintain countertraction. The cystotomy was extended downwards to include the fistula site. The fistula was dissected circumferentially to raise the bladder and vaginal flaps. The vaginal defect was closed in a transverse fashion and the cystotomy was closed vertically.
Mean operative time was 178±31.6 min and estimated blood loss was 60±18.7 mL. Flap interposition was performed in six cases. No intraoperative complications were recorded. Mean hospital stay was 2.25±0.89 days. During hospitalization two patients experienced postoperative complications (Clavien grade I). Mean follow-up was 20.9±11.1 months (6.0-39.0 months). All patients remained continent during the follow-up period.
This minimally invasive laparoscopic approach with only three trocars and limited posterior cystotomy provides excellent results with minimum morbidity.
膀胱阴道瘘（VVF）修复的两种传统方法是经腹修复膀胱三角区上方的VVF和经阴道修复低位瘘。腹腔镜手术被引入以重复经腹手术步骤并降低发病率。我们报告了一系列采用改良腹腔镜技术治疗的患者，该技术仅使用三个套管针并进行有限的后膀胱切开术。
我们回顾性分析了2015年1月至2018年4月期间采用我们的标准化技术进行腹腔镜VVF修复的8例患者的数据。仅纳入膀胱三角区瘘的病例。我们始终仅使用三个套管针。使用超声能量进行2cm的中线后膀胱有限切开术。将直针上的留置缝线经皮穿过腹部，然后穿过膀胱切开术两侧，最后引出以维持对抗牵引。膀胱切开术向下延伸以包括瘘口部位。沿瘘口周围进行解剖以掀起膀胱和阴道瓣。以横向方式关闭阴道缺损，垂直关闭膀胱切开术。
平均手术时间为178±31.6分钟，估计失血量为60±18.7毫升。6例进行了瓣片插入。未记录术中并发症。平均住院时间为2.25±0.89天。住院期间有2例患者出现术后并发症（Clavien I级）。平均随访时间为20.9±11.1个月（6.0 - 39.0个月）。所有患者在随访期间均保持控尿。
这种仅使用三个套管针和有限后膀胱切开术的微创腹腔镜方法效果极佳，发病率最低。
