Comparative Analysis Between Laparoscopic Extravesical Repair and Laparoscopic O'Connor Repair for Supratrigonal Vesicovaginal Fistula.

Abstract

Objective: The objective of the study was to conduct a comparative analysis of various intraoperative parameters and postoperative outcomes between the laparoscopic extravesical repair versus the laparoscopic O'Connor repair techniques in management of supratrigonal vesicovaginal fistula.

Methods: A prospective nonrandomized study was conducted from January 2018 to January 2023, in which 36 patients who met inclusion criteria like primary or recurrent, single, simple, supratrigonal vesicovaginal fistula were included. Among these patients 18 patients were operated with laparoscopic O'Connor repair, while 18 were operated with laparoscopic transperitoneal extravesical vesicovaginal fistula repair. Intraoperative and postoperative parameters of these 2 techniques were compared.

Results: Laparoscopic O'Connor repair had longer operative time of 140 minutes, while laparoscopic extravesical VVF repair had an operative time of 117 minutes (P = .026). Mean blood loss was also significantly higher in laparoscopic O'Connor (210 mL versus 95 mL) (P = .004). Postoperative complications and analgesics requirement were less with laparoscopic extravesical repair. Hence, laparoscopic extravesical repair reduced mean hospital stay (3.2 days versus 3.9 days) (P = .003). A success rate of 83.33% for laparoscopic O'Connor and 94.45% for laparoscopic extravesical repair (P = .153) was recorded.

Conclusion: Laparoscopic extravesical approach appears to be a convenient and effective method in selective supratrigonal vesicovaginal fistula repair.