Presentation Authors: Rakesh Kapoor*, Sanjay Kumar Sureka, Rahul Jena, Lucknow, India
Introduction: Vesico-vaginal fistulae were traditionally repaired by open transvaginal or transabdominal routes. Here we have compared our series of open transvaginal VVF repair with literature reported population matched cohort (LRC) of VVF repair done by laparoscopic or robot assisted techniques.
Methods: 239 patients underwent VVF repair from 2000-2017, which was predominantly approached via transvaginal route (n=229, 95.8%). Trans-abdominal route (n=10, 4.2%) was considered in complex (requiring ureteric reimplantation/ augmentation cystoplasty/ post radiotherapy/ narrow vagina) and in a few recurrent fistulae. The size of fistula, location, operative time, blood loss, major complications, hospital stay and perurethral catheter indwelling time and outcome were recorded. Our TV repair cohort (TVC, n=229) was compared with LRC of 260 patients undergoing VVF repair by minimally invasive techniques.
Results: Overall, success rate in our series was 97% (n=223) vs 96% in LRC. The reported blood loss in literature was inconsistent, upto 450 ml compared to mean blood loss of 80 ml in our cohort. There was significantly shorter operative time of 30-100 (mean 55+9) minutes in our cohort as compared to 70-430 (mean >150) minutes in LRC (p=0.0001) with hospital stay of 3.5 vs 3.2 days in TVC as compared to LRC . Major complication (Clavien Dindo III or more) were 3 in our series vs 5 in reported literature. Majority of our patients were orally allowed by 6 hours after surgery. The cost of surgery at our setup is around 15000 INR for TV repair. The cost by minimally invasive techniques has not been reported but is likely to be at least 5 times higher if it were to be done in our setting.
Conclusions: Transvaginal VVF repair is comparable to literature reported outcome by minimally invasive approach, however transvaginal performed better as far as resource utilization and postoperative recovery is concerned.