ABSTRACT
Background
Vesicovaginal fistula (VVF) is a difficult-to-treat complication of obstetric hysterectomy.
There are multiple management options, with a preference for surgical repair via abdominal
or vaginal approach. We describe a transurethral natural orifice transluminal endoscopic
surgery (NOTES) using barbed suture, in 3 cases of VVF after hysterectomy due to morbidly
adherent placenta (MAP).
Cases
Three patients with VVFs after hysterectomy due to MAP underwent a transurethral endoscopic
suture repair. Two patients had complete resolution of the fistula, and the third
required additional repair by laparotomy; however, a decrease was observed in the
size of the VVF after the initial endoscopic repair.
Conclusion
The transurethral NOTES approach for VVF after MAP hysterectomy is a minimally invasive
procedure that is valid as an initial approach for this type of complication.
RÉSUMÉ
Contexte
La fistule vésico-vaginale est une complication difficile à traiter de l'hystérectomie
obstétricale. Il existe plusieurs options de prise en charge, la stratégie privilégiée
étant la réparation chirurgicale par voie abdominale ou vaginale. Nous décrivons une
technique de chirurgie endoscopique transorificielle (natural orifice transluminal endoscopic surgery ou NOTES) par voie urétrale avec suture crantée utilisée dans 3 cas de fistule vésico-vaginale
post-hystérectomie due à une adhérence morbide du placenta.
Cas
Trois patientes présentant une fistule vésico-vaginale post-hystérectomie en raison
d'une adhérence morbide du placenta ont subi une réparation avec suture crantée au
moyen d'une technique de chirurgie endoscopique transorificielle par voie urétrale.
Deux patientes ont connu une résolution complète de la fistule. La troisième patiente
a dû se soumettre à une réparation supplémentaire par laparotomie; une diminution
de la taille de la fistule vésico-vaginale a toutefois été observée après la réparation
endoscopique initiale.
Conclusion
La technique de chirurgie endoscopique transorificielle par voie urétrale pour traiter
la fistule vésico-vaginale post-hystérectomie due à une adhérence morbide du placenta
est une solution peu invasive et constitue une stratégie initiale adéquate pour ce
genre de complication.
Keywords
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Article info
Publication history
Published online: August 05, 2020
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2020 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
