Laparoendoscopic single-site surgery (LESS) and conventional laparoscopic extravesical repair of vesicouterine fistula: single-center experience.

Purpose: To present for the fist time in literature laparoendoscopic single-site surgery (LESS) extravesical repair of vesicouterine fistula (VUF) and to compare this with conventional laparoscopic repair.

Methods: Eleven females with VUF were included; of them, six had conventional laparoscopic repair where 5 ports were used, while five females had LESS repair. Additional 5-mm port was inserted during suturing in LESS group and both straight and pre-bent instruments were used. Fistulous tract was excised; then, uterine rent was closed through single figure of eight suture, while urinary bladder was closed in two layers; then, an omental flap was interposed in between. Sutures were done using 3/0 vicryl. Urinary bladder was drained for 3 weeks through uretheral catheter.

Results: No conversion to open surgery in both groups or from LESS to conventional repair. Blood loss in conventional laparoscopic and LESS repair was 95 ± 18 and 86 ± 15 c.c., respectively. No complications were reported in both groups. Operative time for conventional laparoscopic and LESS repair was 149 ± 18 and 144 ± 16 min, respectively. Postoperative hospital stay was 3.1 ± 0.8 and 2 days for both groups, respectively. At follow-up period of 23.6 ± 8.2 and 13.4 ± 1.8 months for both groups, respectively, all were cured.

Conclusion: Both conventional laparoscopic and LESS extravesical repair of VUF are effective and reproducible and they follow the same principles of open surgical repair. However, LESS repair of VUF seems to be less morbid than conventional laparoscopic repair.