{"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":"1273-1279"},"PeriodicalIF":1.8000,"publicationDate":"2025-06-01","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":"2025/3/17 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
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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.
简介和假设：膀胱阴道瘘（VVF）是一种毁灭性的产科并发症。经阴道、经腹部、腹腔镜和机器人修复已被提出。本研究通过比较表上VVF修复术的围术期和术后参数，在阴道、腹腔和腹腔镜手术入路中寻找最佳手术入路。方法：2015年1月~ 2021年1月进行准实验研究。总共筛查了175名患有乳腺炎的妇女，并招募了150名患有乳腺炎的妇女。VVF修复采用经阴道、经腹部和腹腔镜入路（每种入路50例）。记录手术成功率、手术时间、出血量、术后并发症及住院时间等参数。采用SPSS Version 21进行统计分析。在招募受试者之前，必须取得书面知情同意书。结果：下（宫）段剖宫产、切开或腹腔镜子宫切除术、难产是常见原因。统计分析显示，阴道修复术的平均手术时间显著低于腹腔镜修复术，而阴道修复术的镇痛需求、住院时间和出血量显著低于腹腔镜修复术。三种入路均出现尿路感染，术后给予抗生素治疗。仅经腹修复组出现轻微伤口感染，常规敷料处理即可解决。随访期间无复发。结论：经阴道和腹腔镜修复是治疗VVF安全有效的方法。然而，腹腔镜修复需要一个陡峭的学习曲线。经阴道修复术的手术时间明显缩短。因此，在单纯性阴道上腔内腔囊肿中，经阴道修复可能是首选的选择。
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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