O’CONOR (TRANSABDOMINAL) REPAIR: IS IT ALWAYS NECESSARY TO INTERPOSE A FLAP IN SIMPLE VESICO-VAGINAL FISTULA? A COMPARATIVE STUDY

Abstract

Objective: To assess morbidity and success of transabdominal (O’Conor) repair of vesicovaginal fistula with or
without interposition of flap between vagina and urinary bladder.

Study Design: Prospective comparative study.

Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2016 to Jan 2019.

Methodology: Fifty five patients were randomized into group A & B by lottery method. An inclusion criterion
was single fistulous opening of ≤3cm. Complex and recurrent fistulae were excluded. Patients in group A underwent O’Conor repair without interpositional flap while in group B vesicovaginal fistulae were repaired with flap interposition.

Results: Twenty two patients were randomized in group A while 27 in group B. Mean age of patients was 41.65
± 11.93 years. Gynecological and obstetrical surgery was the main cause of fistula. Mean duration of surgery
was 162.7 ± 18.49 minutes. Per-operative ureteric catheterization was done in 9 (16.8%) patients. Seventeen
(30.6%) patients had paralytic ileus. There was transient fever in 4 (7.6%) of cases and wound infection was seen
in 3 (5.8%) of patients. Mean hospital stay was 3.4 ± 2.3 days. Cystogram was done in 35 (64.5%) of patients before the removal of per-urethral catheter. The overall success rate was 92.9%. Ten (18.2%) of patients developed denovo urgency which was managed conservatively. There was no statistical difference in both groups in terms of morbidity and success.

Conclusion: In simple Vesico-vaginal fistulae repair, interposition of flap can be omitted and it does not affect the outcomes in terms of success and morbidity.