{"title":"Analysis of Various Surgical Approaches to Supratrigonal Vesicovaginal Fistula Repair: A Tertiary Care Centre Experience.","authors":"Shivani Madhuchandra Iyer, Sanjeet Singh, Alok Srivastav","doi":"10.1007/s00192-025-06104-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Vesicovaginal fistula (VVF) is a devastating obstetric complication. Transvaginal, transabdominal, laparoscopic and robotic repairs have been proposed. This study was carried out to compare peri-operative and post-operative parameters of supratrigonal VVF repair to find out the best surgical approach among vaginal, abdominal and laparoscopic approaches.</p><p><strong>Methods: </strong>A quasi-experimental study was carried out from January 2015 to January 2021. A total of 175 women suffering from VVF were screened and 150 women with supratrigonal VVF were recruited. VVF repair was performed using transvaginal, transabdominal and laparoscopic approaches (50 repairs using each approach). Parameters such as success rate, operative time, blood loss, post-operative complications and hospital stay were recorded. Statistical analysis was carried out using SPSS Version 21. Written informed consent was taken before the recruitment of subjects.</p><p><strong>Results: </strong>Lower (uterine) segment Caesarean section, open or laparoscopic hysterectomy and obstructed labour were the common causes. Statistical analysis showed that mean operative time was significantly lower in vaginal repair, whereas analgesic requirement, hospital stay and blood loss were significantly lower in vaginal and laparoscopic repair. Urinary tract infection was seen in all three approaches, and was resolved by administration of antibiotics post-operatively. Minor wound infection was seen only in the transabdominal repair group, which resolved with the regular application of dressings. None of the patients developed recurrence during follow-up.</p><p><strong>Conclusions: </strong>Transvaginal and laparoscopic repairs are safe and effective approaches for VVF repair. However, laparoscopic repair requires a steep learning curve. Transvaginal repair has a significantly shorter operative time. Hence, in simple supratrigonal VVF, a transvaginal repair can be a preferred option.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":""},"PeriodicalIF":1.8000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Urogynecology Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00192-025-06104-2","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction and hypothesis: Vesicovaginal fistula (VVF) is a devastating obstetric complication. Transvaginal, transabdominal, laparoscopic and robotic repairs have been proposed. This study was carried out to compare peri-operative and post-operative parameters of supratrigonal VVF repair to find out the best surgical approach among vaginal, abdominal and laparoscopic approaches.
Methods: A quasi-experimental study was carried out from January 2015 to January 2021. A total of 175 women suffering from VVF were screened and 150 women with supratrigonal VVF were recruited. VVF repair was performed using transvaginal, transabdominal and laparoscopic approaches (50 repairs using each approach). Parameters such as success rate, operative time, blood loss, post-operative complications and hospital stay were recorded. Statistical analysis was carried out using SPSS Version 21. Written informed consent was taken before the recruitment of subjects.
Results: Lower (uterine) segment Caesarean section, open or laparoscopic hysterectomy and obstructed labour were the common causes. Statistical analysis showed that mean operative time was significantly lower in vaginal repair, whereas analgesic requirement, hospital stay and blood loss were significantly lower in vaginal and laparoscopic repair. Urinary tract infection was seen in all three approaches, and was resolved by administration of antibiotics post-operatively. Minor wound infection was seen only in the transabdominal repair group, which resolved with the regular application of dressings. None of the patients developed recurrence during follow-up.
Conclusions: Transvaginal and laparoscopic repairs are safe and effective approaches for VVF repair. However, laparoscopic repair requires a steep learning curve. Transvaginal repair has a significantly shorter operative time. Hence, in simple supratrigonal VVF, a transvaginal repair can be a preferred option.
期刊介绍：
The International Urogynecology Journal is the official journal of the International Urogynecological Association (IUGA).The International Urogynecology Journal has evolved in response to a perceived need amongst the clinicians, scientists, and researchers active in the field of urogynecology and pelvic floor disorders. Gynecologists, urologists, physiotherapists, nurses and basic scientists require regular means of communication within this field of pelvic floor dysfunction to express new ideas and research, and to review clinical practice in the diagnosis and treatment of women with disorders of the pelvic floor. This Journal has adopted the peer review process for all original contributions and will maintain high standards with regard to the research published therein. The clinical approach to urogynecology and pelvic floor disorders will be emphasized with each issue containing clinically relevant material that will be immediately applicable for clinical medicine. This publication covers all aspects of the field in an interdisciplinary fashion
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