Introduction: Vaginal and abdominal approaches are used to attempt VVF closure but, due to a paucity of literature, there is no evidence to support the use of one over the other. We present the outcomes of our series of patients referred to a tertiary centre for management of a VVF to assess the outcomes of different management strategies and factors that might influence successful closure.
Methods: Retrospective case-note review of all patients who had surgical management of a VVF (September 2002 - April 2021) . Median age was 49 (range 16-88) with a median follow-up of 14months.
Data collected included demographics, co-morbidities, aetiology of fistula, fistula characteristics, previous surgery, subsequent success and further surgery. Statistical analysis was performed.
Results: Of the 122 patients identified, 8 patients had primary urinary diversion. 114 had surgical management for primary closure of the VVF with 86.8% success after first repair. 13/15 primary failures went on to have further attempted closure resulting in an overall success rate of 96.5% after 2nd attempt.
With progression on our learning curve, the approach to surgical management has changed. Between 2002-2011, 53% (25/47) cases were performed abdominally whereas from 2012-2021 this was true for only 18.7% (14/75) and the majority were approached vaginally.
Vaginal closure was successful in 92% (69/75) after 1st repair and 100% after second repair (80% abdominally, 20% vaginally). Abdominal closure was successful in 76.9% (30/39) at primary repair. Of 9 failures, n=7 had a 2nd attempt abdominally with 71.4% successfully closed, n=1 had a successful 2nd closure vaginally and n=1 had an ileal conduit. On statistical analysis there was a statistically significant difference(p < 0.05) between the successful closure rates for a vaginal vs an abdominal approach. No other patient or fistula characteristics predicted successful closure. Post-repair continence was high at 87.3%. 100% of patients with incontinence post-vaginal repair of VVF (n=10) achieved continence with conservative/medical intervention. Incontinence after an abdominal repair (n=4) required surgical intervention in 75%.
Conclusions: A vaginal approach for repair of VVF, in expert hands, gives excellent results with >90% closure rates after one attempt. It is likely that its superiority over an abdominal approach is influenced by other factors not captured on small data sets. This series shows that VVF can be treated successfully with primary closure in the main and have good functional outcomes. Maturation of the series will help to establish other factors that influence outcomes.
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