Back to 2015 Joint Annual Meeting

Introduction- Vesicovaginal fistula repair can be approached either from a transvaginal or abdominal approach. The approach often depends on fistulae location and complexity. We sought to assess the perioperative outcomes for each approach using a large multi-institutional prospectively collected database.
Methods- Patients were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Participant User Files (2005-2012) and Current Procedural Terminology (CPT) codes for vesicovaginal fistula repair. Results were stratified according to abdominal (51900) versus vaginal (57320, 57330) approach. Complications were an outcome of interest, and multivariable logistic regression models were used to assess the impact of preoperative variables and surgical approach on prolonged operative time and length of stay.
Results- Of the 138 vesicovaginal fistula repairs performed during the study period, 38% (n=53) were performed via an abdominal approach and 62% (n=85) via a vaginal approach. Complications were infrequent and did not differ between approaches. The overall complication rate was 10% with the most common complication being urinary tract infection. In multivariable analyses, abdominal approach was found to be associated with both prolonged operative time (Odds Ratio [OR] 7.419, p<0.001) and prolonged length of stay (OR 15.933, p<0.001).
Conclusions- In comparison to the vaginal approach, an abdominal approach to vesicovaginal fistula repair is associated with prolonged operative time and prolonged length of hospital stay. There is not, however, a difference in the rate of perioperative complications. These results suggest that, for amenable fistulae, a vaginal approach may be preferred to an abdominal approach.