Vesicovaginal fistula repair with and without interposed flap; Is there any difference?

Abstract

The abnormal communication between bladder and vagina (Vesicovaginal fistula VVF) is a devastating problem leading to continuous leakage of urine to the vaginal vault and resulting in significant morbidity for the affected female patients. Various techniques have been described for the management of VVF, but with significant recurrence rate of vesicovaginal fistulae. In our study we tried to evaluate the outcome of VVF repair with the use of omental flap interposition, and comparing it with VVF repair without flap. A prospective comparative trial conducted from July 2014 to May 2019, to evaluate the end result of transabdominal VVF repair (with or without interpositional flap) on 33 patients in Tikrit, mostly 3 to 6 months after their diagnosis. Excluding those patientwith a complicated fistula and malignant fistula. The selected patients were randomized into two groups. Group A (18 patients) was repaired with using omental flap, whereas, group B (15 patients) was repaired without omental flap interposition. A total of 33 patients with VVF were included in our study. With amean age of 36.6 years (range 23-43). The majority of VVF (66.5%) occurred as complications of abdominal hysterectomy, and obstructed labor is the second most common cause (account for about 31.5% of the cases). With fistula size ranging from 16 Fr to 30 Fr calibrated using Foly's catheter and finger calibration in larger fistula. The total reported success rate of the surgical repair in this study was 94%.In 18 patients were omentum flap interposition used; all of them except one (94.4%) were cured, while in 15 patients, repair done without flap, 13 (86.6%) patients were dry in the post-operative period. Though omentum flap interposition have good result in preventing recurrence of vesicovaginal fistulae, fistula repair without flap can give a high success, if meticulous dissection and suturing is done.