Pavan Kumar, Gyanendra Singh, Deepa Aggarwal and Mayank Jain
Background: 474 patients who underwent genitourinary fistula repair at a tertiary centre were retrospectively analyzed, to determine the factors affecting the outcome of surgery.
Methods: A retrospective analysis was carried out on 474 patients who underwent transabdominal, transvaginal and laparoscopic repair in the last 15years at our institute. The mean (SD) age was 36 year; 49% of the VVF occurred after abdominal hysterectomy, 32% after obstructed labour and 19% after Caesarean section. Twenty-nine (6.11%) had a previous failed repair operated elsewhere.
Results: Out of 474 VVF, 68 cases had more than one fistula on urethrocystoscopy. Transabdominal repair was done in 245 patients, transvaginal repair in 156, total laparoscopic procedure was attempted in 49 and conservative approach in 24patients. The average duration of urethral catheter placement (SD) was 22 (3.9) days. A total of 219 patients were left indwelling catheters in view of nearness to the orifice. The success rate of primary operation for open transabdominal, transvaginal, laparoscopic and conservative approach were 90%, 91.66%, 95% and 63% respectively. only the surgical technique and previous history of repair were significant factors in the univariate analysis of variables that could affect surgery success. In multivariate analysis, only the previous intervention and surgical approach remained significant.
Conclusion: In surgical correction of VVF, both abdominal and vaginal approach seems to have comparable success. Laparoscopic VVF repair is evolving in a rapid trend because of its reduced morbidity, minimal blood loss, short hospital stays and high success rates. History of previous repair and the surgical factors determined the success rate of VVF repair. Recurrent VVF are being associated with lower success rates than primary cases at our institute