Objectives <p>To report our experience in using inter-positional peritoneal flap in repair of vesico-uterine fistula and to assess the efficacy and safety of this technique.</p> Materials and Methods <p>From July 2018 to April 2023, 40 women had open repair of vesico-uterine fistula through a transperitoneal approach. After bivalving the bladder down to one cm distal to the fistula, the anterior wall of the uterus was closed in transverse manner, while the bladder was closed longitudinally. A peritoneal flap was developed from the peritoneal covering of the bladder dome and used as an inter-positional flap between the bladder and the uterus.</p> Results <p>Median (range) age of the included women was 35 (20–48) years, and median (range) size of the fistulae was 12 (3–30) mm. All cases had developed vesico-uterine fistula after cesarean section. Median (range) operative time was 100 (65–150) minutes. No intraoperative complications were encountered, while five patients (12.5%) had minor (Clavien I) postoperative complications. The maneuver was successful for all patients. One patient got pregnant after the repair and had an eventless cesarean section on delivery.</p> Conclusions <p>Open repair of vesico-uterine fistula with inter-positional peritoneal flap had a success rate of 100% with a favorable safety profile.</p>