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Laparoscopic Vesicovaginal Fistula Repair with Drs. Miklos and Moore
Drs. Miklos and Moore have been performing laparoscopic vesicovaginal fistula repair surgery aka bladder fistula surgery for 15 years and are considered to be the foremost authorities in laparoscopic vesicovaginal fistula repair or robotic vesicovaginal fistula repair. (click here to read paper) Drs. Miklos and Moore introduced the first known laparoscopic extravesical vesicovaginal fistula repair in the United States in 1998. (click here to read paper).
Bladder fistulas have been traditionally repaired through larger abdominal incisions known as laparotomies. Here at International Urogynecology associates they have more experience than anyone in the world doing a laparoscopic vesicovaginal fistula repair. Laparoscopy means using miniature incision to introduce a telescope through the abdomen to do the surgery. Drs. Miklos and Moore can repair fistulas with greater detail and complete visualization than either by the vaginal or abdominal approach. They have a vesico vaginal fistula repair cure rate of 98% over 15 years of surgery. (click here to read paper).
A testament to Dr. Miklos's and Dr. Moore's approach and success can be found in that urogynecologists, urologists and gynecologists have referred patients from New York, Vancouver B.C., North Carolina, Mississippi, Indiana , Pennsylvania , Georgia and Alabama for laparoscopic repair of previously failed fistula surgeries. Drs. Miklos and Moore have performed their laparoscopic vesicovaginal fistula repair surgery on 13 patients with previously failed repairs and have been successful in all 13 patients giving them a 100% cure rate. Four of these 13 patients had a previous omental flap during their initial repair and still had a surgical vesicovaginal fistula repair failure. Drs. Miklos and Moore were able to cure these previously operated on patient with a single laparoscopic vesicovaginal fistula repair surgery. (click here and here to read papers)
Bladder Fistula Surgical Repair Technique
Here are some pictures taken during a Fistula Repair Surgery:
Picture 1--shows opening the fistula tract with
the bladder above and the vagina below
Picture 2--shows the separation of the stent
and the fistula; the hole above is the bladder
and the one below is the vagina
Picture 3—shows the hole in the bladder after
cutting away the fistula scar of the bladder
(now it appears larger than before)
Picture 4—shows closing the edges of the
bladder using a suture and needle
Picture 5---shows the placement of our 6th
suture (out of 7) closing the bladder hole in an
area of less than 1 inch (this is the first line of
closure, we reinforced this closure with a
second layer of sutures)
Picture 6—shows a bladder full of water
testing the integrity of our surgical repair. We
tested the tightness of the repair only after
doing a two layer closure on the bladder.
Possible Complications of Vesicovaginal Fistula Repair
Patients undergoing a vaginal fistula repair surgery can experience intra and post operative complications including, but not limited to, the following:
- Post Operative Failure
- Recurrent Fistula Formation
- Injury to Ureter, Bowel, or Intestines
- Vaginal Shortening
Drs. Miklos and Moore's complication rate is as follows:
- Recurrent Fistula Formation - 2%
- Injury to Ureter, Bowel, or Intestines - 0%
- Vaginal Shortening - 0%
Though many institutions where vesicovaginal fistulas are repaired would also state that vaginal shortening is a potential complication, this is minimized and a rarity when performing vesicovaginal fistula repair laparoscopically.
Because most patients with fistulas have had previous fistula surgery, a laparoscopic fistula repair can be a complex procedure. Our success rate is greater than 90%. Some patients referred to us have had more than 3 previous attempts at vesicovaginal fistula repair, but after one laparoscopic approach, they have been cured of their fistula and its symptoms.
Because many patients with fistulas have had previous fistula surgery, a laparoscopic fistula repair can be a complex procedure. Approximately 25% (13/50) of our patients have had previous vesicovaginal fistula repairs and then failed from other surgeons. We have a 100% cure rate with patients with previous failed vesicovaginal surgery. Some patients referred to us have had 2,3 and even 4 attempts at vesicovaginal fistula repair, but after one laparoscopic approach by Drs. Miklos and Moore, they have been cured of their fistula. (click here to read paper) So if have a vesicovaginal surgical failure, consider Drs. Miklos and Moore as your first choice as your experts for fistula repair surgery.