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Transluminal approaches to vesicorectal fistula repair

INTRODUCTION

Vesicorectal fistula is a devastating postoperative complication after radical prostatectomy. Definitive treatment is difficult. Despite many options, currently there is not one universally accepted approach.

OBJECTIVES

We describe two new minimally invasive approaches for the repair of vesicorectal fistula.

METHODS

We treat two patients with vesicorectal fistula after radical prostatectomy. In the first case, we perform the repair using Transanal Minimally Invasive Surgery (TAMIS) with standard laparoscopic instrumentation. We use Alexis device for transanal access, one rigid 10mm port for 0 degress endoscope and two minilap 3mm ports for surgical manipulation. The surgical steps were: Cystoscopy and implant of guide wire on fistula; Positioning; Transanal access; Identification of the fistula; Dissection; Closure of vesical wall; Injection of fibrin glue in the defect; Closure of rectal wall. In the second case, we perform the repair using Transvesicoscopic Surgery. We use one rigid 10mm port for 0 degress endoscope and two 5mm ports for surgical manipulation. The surgical steps were: Positioning; Transvesical access; Identification of the fistula; Dissection; Closure of rectal wall; Closure of vesical wall.

RESULTS

Mean operation time was 225 minutes, with a time of surgery slightly higher in TAMIS. The time of dissection was similar (120 minutes). No perioperative complications and conversion were observed. Hospital stay was 2 days and the catheters were removed at 4 weeks. No recurrence was observed.

CONCLUSIONS

The greatest difficulties were maintaining luminal dilation, instrumental manipulation and suturing. Nevertheless, these new approaches are feasible, with low morbidity.

Publication Dates

  • Publication in this collection
    Mar-Apr 2014

History

  • Received
    01 Dec 2013
  • Accepted
    30 Jan 2014
Sociedade Brasileira de Urologia Rua Bambina, 153, 22251-050 Rio de Janeiro RJ Brazil, Tel. +55 21 2539-6787, Fax: +55 21 2246-4088 - Rio de Janeiro - RJ - Brazil
E-mail: brazjurol@brazjurol.com.br