Outcome of early transabdominal suprapubic repair of vesicovaginal fistula secondary to benign gynecological and obstetric surgeries.
DOI:
https://doi.org/10.52764/jms.24.32.1.5Keywords:
Vesicovaginal fistula, early repair, hysterectomy.Abstract
ABSTRACT:
Objective: To determine the effectiveness of early operative management of patients with Vesicovaginal fistula (VVF) secondary to benign gynecological surgeries.
METHODOLOGY: It was a cross sectional study carried out from August 2018 to Oct 2022. All 70 patients meeting inclusion criteria had routine lab investigations, imaging, cystoscopy and vaginoscopy. The suprapubic approach described by O’Conor et al; was used. All surgeries were performed between 4th and 6th weeks after the onset of fistula to allow some time for tissue healing. All patients were followed after 2 weeks; a cystogram was performed to document fistula closure followed by removal of foleys catheter. A second follow up was at 3 months, patients were assessed with patient global impression of improvement score (PGI-I) for improvement in symptoms.
RESULTS: The mean age of the patients was 40.6 ± 10.2 years. 14(19.7%) patients were primipara while 56 (78.9%) patients were multipara. The mean fistula size was 11.5 ± 4.5mm. Supra-trigonal fistulas were more common than trigonal fistulas [43(60.6%) vs 27(38%)]. Hysterectomy (including cesarean hysterectomy and simple hysterectomy) was the commonest cause of VVF followed by cesarean section and difficult labour [33(46.5% vs 21(29.6) vs 12(16.9%)]. The overall mean operative time was 125.3 ± 10.7 minutes. The mean hospital stay was 3.8 ± 0.8 days. The fistula was successfully closed in 64 (90.1%) patients while 6 (9.9%) patients had failed surgery. The small size fistulas (5-10mm) had higher success rate of closure than larger fistulas (11-20mm) with statistical significance (p = 0.02). Over 63(90 %) patients responded PGI score below 3 with much improvement of symptoms.
CONCLUSION: Our results show that early operative management of VVF secondary to benign gynecological and obstetric surgeries is feasible and effective. It also improves symptoms of patients on PGI-I score.
KEY WORDS: Vesicovaginal fistula (VVF), early repair, hysterectomy.
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Copyright (c) 2024 Hazrat ullah, Nasir Khan, Ahsan Rafi, Ishtiaq ur Rehman, Mahjabina S Ghayur
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