Prospective randomized comparison of repairing vesicovaginal fistula with or without the interposition flap: Result from a tertiary care Institute in Northern India

Özet

Objective: Assessment of results of repairing vesicovaginal fistula (VVF) with or without the use of interposition flaps.Material and methods: This prospective randomized study was conducted between January 2012 to December 2017 in the Department of Urology, King George’s Medical University, Lucknow, India. Obstetricand gynecological simple fistula of ≤4 cm were included for evaluation. Those with complex or complicatedfistula or fistula due to malignancy were excluded. Patients were divided into two groups (group 1 and group2) depending upon route of repair i.e., transvaginal or transabdominal, respectively, as per the characteristicsand location of the fistula. These two groups of patients were randomized into two subgroups (1A, 1B and2A, 2B) based on the inclusion or omission of the interposition flap during fistula repair. Perioperative andpostoperative parameters (blood loss, mean operating time, hospital stay, and requirement of analgesics) andsuccess rates of fistula repair were compared. All complications that occurred in the postoperative periodtill the last follow-up appointment were recorded. The Clavien-Dindo Classification was used to stratify thecomplications.Results: Fifty-seven patients underwent transvaginal repair in group 1 (29 with Martius flap: group 1A;28 without Martius flap: group 1B), while 69 patients underwent transabdominal repair in group 2 (35 withinterposition flap: group 2A; 34 without flap: group 2B). Blood loss, mean operating time, hospital stay, andthe requirement of analgesics were comparable between each subgroup-1A versus 1B and 2A versus 2B,respectively. The overall success rate of repair across all groups was 96.04% (121/126). The success rate was93.1% in transvaginal repair with Martius flap versus 96.43% in transvaginal repair with no flap (p=1.0).Success rate was 97.1% in transabdominal repair with an omental flap versus 97.06% in without an omentalflap (p=1.0). Mean follow-up period was 39.6 months (range: 6-68 months). Out of 29 patients with Martiusflap interposition, 9 (31.03%) of them reported a significantly reduced sensation on the labia majora. Ofthese 9 patients, 5 reported numbness while the remaining 4 experienced pain as compared to the patientsin subgroup IB, who did not report any altered sensation in the labia. (p=0.0019).Conclusion: The success rates are similar in simple VVF repair (fistula size less than 4 cm) irrespective ofthe use of interposition flaps. However, overall morbidities following repair with the interposition flap arehigher when compared with repair without interposition flap, either by the transvaginal or by the transabdominal route.