Login to Access Video or Poster Abstract: MP40-17
Sources of Funding: none

Introduction

Outcome assessment of simple vesicovaginal fistula (VVF) repair with or without the use of interposition flaps.

Methods

This prospective randomised study was conducted between 2012 to 2015 in department of Urology King George’s Medical University, Lucknow. Obstetric and gynaecologic fistula less than 4 cm were included. Those with complex or complicated fistula and fistula due to malignancy were excluded from this study. Patients were divided into two groups (group 1 and group 2) depending upon route of repair i.e. transvaginal or transabdominal respectively as per characteristics and location of fistula. These two groups were randomised into two subgroups (1A, 1B and 2A, 2B) based on with use and without use of interposition flap during fistula repair. Perioperative and post-operative parameters (blood loss, mean operating time, hospital stay, requirement of analgesics) were compared. All complications occurred in postoperative period till last follow –up were recorded and Clavien Dindo Classification was used to stratify them.

Results

_x000D_ Fifty-four patients underwent transvaginal repair- group 1 (27 with Martius flap-group 1A and 27 with no Martius flap – group 1B). Sixty-six patients underwent transabdominal repair-group 2 (33 with interposition flap- group 2A and 33 with no flap – group 2B). Blood loss, mean operating time, hospital stay, requirement of analgesics were comparable between sub-group 1A versus 1B; and 2A versus 2B. Overall success rate of repair across all groups was 92.7% (115/124). Success rate was 88.9% in transvaginal repair with martius flap versus 92.6 % in transvaginal repair with no flap (P=1.0) and it was 93.9 % in both subgroups of transabdominal repair (P=1.0). Mean follow up period was 33.6 months (range 12-46). 9 out of 27 patients (33.3%) with Martius flap interposition had significantly reduced sensation on labia majora. Of these 9 patients, 5 cases reported numbness and 4 had pain compared to patients in group IB who did not report any altered sensation in labia. (P = 0.001).

Conclusions

The success rates are similar in simple VVF repair irrespective of the use of interposition flaps. However, overall morbidity following repair with interposition flap is more when compared with repair without interposition flap either by transvaginal or by transabdominal route.

Funding

none