Robotic vesicovaginal fistula repair using double-layer urachal and omental flap interposition: a retrospective case series

Vesicovaginal fistula (VVF) remains a challenging condition requiring precise surgical repair to achieve durable closure, and robotic-assisted techniques provide enhanced visualization and dexterity, particularly in complex or recurrent cases. This retrospective study evaluated the outcomes of a double-layer interposition technique using urachal and omental flaps in 5 patients who underwent robotic transabdominal VVF repair between January 2023 and June 2025, all of whom had supratrigonal fistulae confirmed by cystoscopy and computed tomography urography + cystography. The surgical approach involved layered closure of the fistula tract followed by placement of vascularized urachal and omental flaps, with perioperative parameters, postoperative complications, and fistula closure rates recorded. The mean patient age was 46.2 years; hysterectomy was the predominant etiology in 80% of cases; 3 patients had previously failed transvaginal repair, and the mean fistula size was 1.8 cm. The mean operative time was 178 minutes with a mean blood loss of 90 mL, and no intraoperative complications were observed; 1 patient developed a Clavien-Dindo grade II urinary tract infection postoperatively. Complete fistula closure was demonstrated in all patients on postoperative cystography, with catheter removal between 16 and 21 days, and at a mean follow-up of 8.6 months, all patients remained continent without recurrence, suggesting that robotic-assisted VVF repair with combined urachal and omental flap interposition is safe, feasible, and associated with excellent short-term outcomes, with dual-layer reinforcement providing improved vascular support and suture-line separation that may reduce recurrence in complex or previously failed cases, although larger prospective studies are required for further validation.