Surgical technique for vesicovaginal fistula repair using the transvaginal flap-fistula offset method

Abstract

Vesicovaginal fistula (VVF) is the most common type of urogenital fistula. It is typically caused by iatrogenic injuries, such as those sustained during pelvic surgery. Transvaginal repair is considered the preferred approach due to its minimally invasive advantages. However, the traditional Latzko procedure or layered closure techniques often sacrifice an excessive amount of vaginal wall tissue, which can lead to postoperative vaginal shortening and dyspareunia. This study aims to introduce a modified transvaginal flap-fistula offset repair technique. This technique utilizes the offset suturing of anatomical layers. This not only improves the fistula closure rate but also maximally preserves vaginal length and function. A 48-year-old patient who developed a VVF following a total hysterectomy successfully underwent this procedure. The operative time was 45 minutes, with an estimated intraoperative blood loss of 5 ml. The urinary catheter was removed 4 weeks postoperatively, and the patient experienced no urinary leakage. At the 3-month postoperative follow-up, cystoscopy revealed complete closure of the fistula. Her vaginal anatomical morphology and length recovered well, without any sexual dysfunction. The postoperative Female Sexual Function Index questionnaire score improved from 6 preoperatively to 27. The transvaginal flap-fistula offset method can construct a robust tissue barrier and avoid overlapping suture lines. It is a safe, effective, and minimally invasive repair option that maintains vaginal length.