Pakistan Armed Forces Medical Journal (Feb 2021)

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

  • Asma Rizwan,
  • Qamar Zia,
  • Adil Khurshid,
  • Mudassar Sajjad,
  • Muhammad Nawaz,
  • Muhammad Akmal,
  • Faran Kiani

DOI
https://doi.org/10.51253/pafmj.v71i1.3599
Journal volume & issue
Vol. 71, no. 1
pp. 347 – 350

Abstract

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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.

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