A 55 year old female presented with incontinence secondary to urethral diverticulum; resected in 2005. Patient developed urethro-vaginal fistula postoperatively; repaired primarily in 2006. Patient presented 2 years later with worsening incontinence. In 2008, Cystoscopy revealed a duplicate urethra and an abnormal distal opening in anterior vaginal wall. She was therefore offered laparoscopic omental interposition for repair of fistula.

The procedure was undertaken in three stages; Omental mobilization, Fistulectomy and omental-interposition. Patient was prepped and placed in lithotomy position. After introduction of Laparoscopic trocars, the omentum was inspected. It was adherent to anterior abdominal wall. Once separated from the abdominal wall the Omentum was mobilized from mid transverse colon, splenic flexure and lateral portion of greater curvature of stomach. The left gastro-epiploic artery was ligated leaving the arterial arch intact with the omental reflection; the right gastro-epiploic artery was left patent. Simultaneously, urethro-vaginal fistulectomy was performed. Pelvic peritoneal reflection was incised; dissecting through the endopelvic fascia the omentum was advanced and pulled caudally. Once the omental flap was anchored in place covering fistula site, the anterior vaginal wall was closed. Urethral and supra-pubic catheters were placed.

With an uncomplicated course postoperatively; successful leak-proof voiding was demonstrated after removing urethral catheter and clamping supra-pubic catheter. Voiding Cystogram done 8 weeks postoperatively, showed minimal residual-volume without any leak or extravasation.

Omental-flap offers a chance to cure recurrent urethro-vaginal fistula. Adequate omentum with intact vascularity can easily be mobilized laparoscopically; offering early postoperative ambulation with reduced morbidity and mortality as compared to celiotomy.