Hypothesis / aims of study
Aim-To study the effectiveness of Transvaginal repair of Supratrigonal Vesicovaginal Fistula
Introduction
Surgical approaches for VVF repair are the transvaginal route, the trans-abdominal/trans-vesical approach, the laparoscopic/robotic approach, and combined techniques. The transabdominal approach is preferred for supra-trigonal VVFs, and the transvaginal approach is preferred for infra-trigonal VVFs (1). There is a scarcity of literature on the comparison between transvaginal and transabdominal approaches for supra-trigonal vesicovaginal fistulas.
Study design, materials and methods
A retrospective analysis was done of forty-nine patients who underwent VVF repair for a simple supra-trigonal vesicovaginal fistula between July 2020 and December 2023 at our centre. Fistula repair was done after 4-6 weeks of iatrogenic fistulas and 12 weeks after the obstetric fistulas. Seventeen patients underwent VVF repair by transvaginal technique, and thirty-two patients underwent VVF repair by robot-assisted laparoscopic technique. Simple fistulas were considered, which were primary, less than three cm in size, non-malignant, normal vaginal length, and had no history of radiation exposure.
Statistics
Data was arranged or entered in a Microsoft Excel spreadsheet. All care was taken to ensure that there was no data entry error. Categorical variables were described as frequency and proportion. Continuous variables were described as mean ± standard deviation or median, with an interquartile range as applicable. We compared categorical data by using the Chi square test and Fisher's exact test as and when required. The data was analysed using SPSS 25. A 95% confidence interval and a p-value less than 5% were considered statistically significant.
Results
Patients' data on age and comorbidities were similar (p > 0.05). Out of 49 patients, 46 (93.9%) were post-hysterectomy, two (4.1%) were post-LSCS, and one patient (2%) had a history of obstructed labour. 95.9% (47 out of 49) patients had a single fistula, and two (4.1%) patients had a multiple fistula. The average fistula size in the transabdominal group and the transvaginal group was 1.20+/-0.84 cm and 1.05+/-0.55 cm, respectively. The average time between fistula formation and fistula repair was 3.4+/-1.50 months and 3.4+/-1.46 months, respectively, in the transabdominal group and transvaginal group. The average operative time was higher in the transabdominal technique in comparison to the transvaginal technique. However, this difference was not statistically significant. There was no significant difference between the two groups in terms of estimated blood loss, duration of hospital stay, or postoperative complications.
Interpretation of results
there was no difference between transvaginal and transabdominal VVF repair in terms of intraoperative blood loss, duration of hospital stay, complication rate, and dyspareunia. We found a difference in terms of the duration of surgery, as the duration of surgery was higher in the transabdominal group in comparison to the transvaginal group, but this difference was not statistically significant.