Autoplastic closure of vesicovaginal fistulae with posterosuperior bladder flap (Gil-Vernet operation)

OBJECTIVE: To describe our experience in the treatment of vesico-vaginal fistula with autoplastic closure using a postero-superior vesical flap. Also, to discuss the technical details of the procedure. MATERIAL AND METHOD: Between 1985 and 1996, 15 patients with vesico-vaginal fistulae secondary to gynaecological surgery were operated. The fistula was considered complex in 5 patients based on previous attempts for surgical closure, number of openings or because they were located in the posterior gradient of the vesical neck. In all cases, autoplastic closure of the fistula was done with a vesical flap through an extraperitoneal abdominal approach. RESULTS: In 100% cases closure of the fistula was achieved at the first surgical attempt. There was no need to interpose vascular tissue between the bladder and the vagina to secure closure of fistula. Post-operatively, 5 patients showed decreased vesical capacity which was recovered within six months; two patients had non-obstructive post-surgical vesical instability. No patient had changes in the mechanism of urinary continence.