Umcomplicated midvaginal vesico-vaginal fistula repair in Ibadan: a comparison of the abdominal and vaginal routes

Abstract

Background: Obstetric fistula is a resultant effect of prolonged obstructed labour. The best surgical management of simple uncomplicated fistula deter mines the outcome of care. Objective: To compare outcome of uncomplicated mid-vaginal fistula between vaginal and abdominal route of repair. Materials and Method: This was a hospital based retrospective study conducted at the University College Hospital, Ibadan from Januar y, 2000 till December, 2006. Result: Of the 71 midvaginal fistulae managed, 40.8% had abdominal repair while the remainder were through vaginal approach. The overall repair success rate was 79.2% with comparable outcome in both groups-78.3% for the abdominal and 80% for the vaginal group ( p=0.999 ) . The duration of hospital stay did not differ significantly between the groups ( p=0.972 ) . Post operative complications were found in 41.4% of the abdominal group compared to none in the vaginal group ( p<0.001 ) . The complications were failed repair ( 20.7% ) and urinar y tract infection ( 20.7% ) . The mean estimated blood loss was 465.5ml in the abdominal group compared to 332.9ml for the vaginal group ( p=0.303 ) . Conclusion: Despite the comparable surgical repair outcome of the two methods, the vaginal approach is associated with l e s s e r bl o o d l o s s a nd l o we r r i s k o f p o s t - o pe r a t i v e complications. It is recommended that the vaginal route should be employed in the repair of uncomplicated midvaginal fistula unless there are other compelling reasons to the contrar y.