The surgical treatment for complex vesicovaginal fistula

Abstract

Objective To discuss the outcomes of transvaginal repair and transabdominal repair for complex vesicovaginal fistula (VVF). Methods The data of complex VVF patients undergoing surgical repair in Peking University First Hospital were retrospectively collected between January 2009 and December 2016. The surgical modalities for complex VVF included transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition. The subtype distribution of complex VVF in transabdominal repair group and transvaginal repair group were recorded. The present study included 63 complex VVF patients with the median age of 46 years (range 26 - 60 years). There were 32 cases undergoing transvaginal repair with layered closure and 31 cases undergoing transabdominal repair with full thick vascular peritoneal interposition. The proportion of cases having failed previous repairs was significantly higher in transvagical repair group (30/32 vs. 23/31, P=0.034). Compared with patients with transvaginal repair, patients with transabdominal repair tended to have multiple VVF without statistic significance (18.8% vs. 29.0%, P=0.338). Patients with transabdominal repair had larger VVF than patients with transvaginal repair (median: 1.0cm vs. 0.5cm, P<0.001). Results There were 2 cases suffering from fat liquefaction of surgical incision and 1 case suffering from adhesive intestinal obstruction in patients undergoing transabdominal repair. In the median follow-up duration of 24 months (range 8-102 months) and 29 months (range 8-78 months), the successful rates of transvaginal repair and transabdominal repair were 75% (24/32) and 93.5% (29/31). Severe lower urinary tract symptoms occurred in one patient who had urine leakage after transabdomnal repair. The bladder volume of patients in transabdominal group recovered at postoperative 3-6 months. Conclusions In consideration of surgical invasion and fistula condition, transvaginal repair with layered closure and transabdominal repair with full thick vascular peritoneal interposition should be performed individually for complex VVF. Meanwhile, the surgeons need pay attention to other perioperative management. Key words: Complex vesicovaginal fistula; Transvaginal repair; Transabdominal repair; Treatment effect