Laparoscopic transperitoneal extravesical approach to vesicovaginal fistula repair without omental flap: a novel technique

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Introduction and hypothesis

The O'Connor bladder bivalving technique remains the traditional abdominal approach to vesicovaginal fistula repair whether performed via laparotomy or laparoscopy.


This video depicts a new surgical technique utilizing a laparoscopic transperitoneal extravesical approach without invasive bladder bivalving or an omental flap. This technique was first described in 1999 and has been utilized on >40 patients with either primary or recurrent vesicovaginal fistulas.


A 98% success rate is reported.


This alternative technique can be performed using either a laparoscopy or the traditional laparotomy approach.

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  1. 1.

    O’Connor VJ Jr (1980) Review of experience with vesicovaginal fistula repair. J Urol 123:367–78

  2. 2.

    Miklos JR, Sobolewski C, Lucente V (1999) Laparoscopic management of recurrent vesicovaginal fistulal Int Urogynecol. J Pelvic Floor Dysfunct 10(2):116–17

  3. 3.

    Abdel-Karim AM, Mousa A, Hasouna M, Elsalmy S (2011) Laparoscopic transperitoneal extravesical repair of vesicovaginal fistula. Int Urogynecol J 22(6):693–7

  4. 4.

    Miklos JR, Moore RD (2012) Failed omental flap vesicovaginal fistula repair subsequently repaired laparoscopically without an omental flap. Female Pelvic Med Reconstr Surg 18(6):372–3

  5. 5.

    Miklos JR, Moore RD (2012) Vesicovaginal fistula failing multiple surgical attempts salvaged laparoscopically without an interposition omental flap. J Minim Invasive Gynecol 19(6):794–7

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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Conflicts of interest


Author information

Correspondence to John R. Miklos.

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Miklos, J.R., Moore, R.D. Laparoscopic transperitoneal extravesical approach to vesicovaginal fistula repair without omental flap: a novel technique. Int Urogynecol J 26, 447–448 (2015) doi:10.1007/s00192-013-2292-7

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  • Vesicovaginal fistula
  • Laparoscopic vesicovaginal fistula
  • Bladder fistula
  • Urogenital fistula
  • Laparoscopic vesicovaginal fistula repair