Prevention

In operative laparoscopy, meticulous dissection of vesicovaginal space and good hemostasis are essential for prevention of vesicovaginal fistula.

Based on a study on mongrel dogs by Cogan et al. (9), cystotomy induced by electrosurgery during laparoscopic hysterectomy, can be a risk factor for formation of vesicovaginal fistula. Caution should be exercised when using electrosurgery in the vicinity of the bladder. The benefit of electrosurgical burn margin excision or omental flap interposition remains unclear, but both are accomplished easily with little risk and may play a role in fistula prevention. In another study on mongrel dogs, Sokol et al. (17) concluded that double-layer bladder closure appeared to be superior to single-layer repair for prevention of vesicovaginal fistula after monopolar cystotomy. Meticulous suture placement and avoidance of tissue strangulation are also essential for prevention of vesicovaginal fistula. During operative laparoscopy performed to treat extensive endometriosis, intentional or unintentional bladder lacerations, or ureteral injury are recognized complications. Repair of a resected ureter or closure of the bladder can be effectively accomplished endoscopically by experienced laparoscopic surgeons. This will prevent the complication of vesicovaginal fistula that requires reoperation (18-20).

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