Robotic Repair of Supratrigonal Vesicovaginal Fistula with Sigmoid Epiploica Interposition.

Derrick J Sanderson, John Rutkowski, Bashir Attuwaybi, Abeer Eddib
Author Information
  1. Derrick J Sanderson: Millard Fillmore Suburban Hospital, Williamsville, New York, USA.
  2. John Rutkowski: Western New York Urology Associates, Cheektowaga, New York, USA.
  3. Bashir Attuwaybi: Buffalo Medical Group, Colorectal Surgery Department, Williamsville, New York, USA.
  4. Abeer Eddib: Western New York Urology Associates, Cheektowaga, New York, USA.

Abstract

INTRODUCTION AND HYPOTHESIS: In the United States, vesicovaginal fistula (VVF) most often results from gynecologic surgery causing significant morbidity and distress to both the patient and surgeon. The use of tissue interposition at time of primary repair has been advocated to decrease the risk of recurrence. The aim of this study is to describe our experience with interposition of sigmoid epiploica during robotic extravesical repair of supratrigonal VVF.
METHODS: This is a retrospective case series from June 2015 to September 2016. Features of the surgical technique include 1) cystoscopic ureteral catheterization, 2) cannulation of the fistula, 3) mobilization of the bladder from the vagina, 4) removal of the epithelialized edges of the fistulous tract, 5) single-layer closure of the vagina, 6) tension-free layered closure of the bladder, 7) retrograde fill of the bladder to ensure water-tight repair, 8) interposition of sigmoid epiploica appendage(s), and 9) prolonged bladder drainage with indwelling transurethral catheter.
RESULTS: In total, 5 women underwent successful robotic VVF repair with epiploic appendage interposition. Mean surgical time was 218 minutes with an average console time of 147 minutes and an estimated blood loss of 49 mL. Most the patients were discharged to home on postoperative day 1 with no untoward effects due to the epiploica interposition. There have been no recurrences to date.
CONCLUSIONS: Robotic repair of VVF with sigmoid epiploica interposition is efficient and well tolerated. Use of this technique may increase the number of patients eligible for tissue interposition.

Keywords

References

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MeSH Term

Adult
Aged
Blood Loss, Surgical
Colon, Sigmoid
Female
Gynecologic Surgical Procedures
Humans
Middle Aged
Operative Time
Retrospective Studies
Robotic Surgical Procedures
Vesicovaginal Fistula

Word Cloud

Created with Highcharts 10.0.0interpositionrepairepiploicaVVFbladderfistulatimesigmoidRobotictissueroboticsurgicaltechnique1vagina5closureappendageminutespatientsVesicovaginalSigmoidINTRODUCTIONANDHYPOTHESIS:UnitedStatesvesicovaginaloftenresultsgynecologicsurgerycausingsignificantmorbiditydistresspatientsurgeonuseprimaryadvocateddecreaseriskrecurrenceaimstudydescribeexperienceextravesicalsupratrigonalMETHODS:retrospectivecaseseriesJune2015September2016Featuresincludecystoscopicureteralcatheterization2cannulation3mobilization4removalepithelializededgesfistuloustractsingle-layer6tension-freelayered7retrogradefillensurewater-tight8s9prolongeddrainageindwellingtransurethralcatheterRESULTS:totalwomenunderwentsuccessfulepiploicMean218averageconsole147estimatedbloodloss49mLdischargedhomepostoperativedayuntowardeffectsduerecurrencesdateCONCLUSIONS:efficientwelltoleratedUsemayincreasenumbereligibleRepairSupratrigonalFistulaEpiploicaInterposition

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