Robotic Repair of Supratrigonal Vesicovaginal Fistula with Sigmoid Epiploica Interposition

Introduction and Hypothesis: In the United States, vesi-covaginal 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) pro-longed 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 postoper-ative 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 epi-ploica interposition is efficient and well tolerated. Use of this technique may increase the number of patients eligi-ble for tissue interposition.