Transvaginal repair of apical vesicovaginal fistula via vaginal natural orifice transluminal endoscopic surgery (V-NOTES): a modified surgical technique and its outcomes

To report the procedure of an alternative modified transvaginal repair technique (V-NOTES) and their outcomes in apical vesicovaginal fistula. Between January 2020 and January 2023, gynecological procedures resulted in the diagnosis of apical VVFs in 26 patients, 17 of whom had undergone transvaginal repair of apical vesicovaginal fistula via vaginal V-NOTES. Those patients were contacted and followed up. Outcomes included operative time, blood loss, success rate, postoperative hospital stay. The average age of the patients was 45.82(36-53) yr. The mean duration between onset of fistula and repair was 7.18(3-12) mo. The mean estimated blood loss was 10.45 ± 3.23 ml, and the average operative time was 104.2 ± 12.2 min. Patients' postoperative hospital stay was 3.34 ± 0.72 days on average. The VVF was successfully repaired in 15(88.2%) cases, and failure was observed in 2 patients. All the 2 initial failures were cured in the second repair. No major complications developed in all 17 patients. There were also no fever (> 38℃), urge incontinence or infection in incision area. Our study suggest that the transvaginal repair of apical VVF via V-NOTES is effective and safety, and offers anticipated results without obvious complications.