Obstetric vesico-vaginal fistula repair: Should we trim the fistula edges? A randomized prospective study

Abstract

Objective: To test the hypothesis that not trimming the edges of the vesico-vaginal fistula (VVF) during its surgical repair has an advantage in the outcome as compared to the classical teaching of trimming the fistula. Methodology: Sixty-four females with obstetric VVF were randomized into two groups. Both groups were treated with vaginal anatomical closure in three layers with Martius flap inter-positioning. Fistulae of the first group were closed without trimming the edges of the bladder while the second group was subject to trimming of the bladder edges. Results: There were no statistically significant differences between both groups regarding pre-operative patient demographics and fistula characteristics. Cure rates were 75% and 67.6% in the non-trimming and the trimming groups, respectively. This was not statistically different. When patients were stratified according to the number of previous repairs, 100% patients in both groups were cured in cases of primary repair of the fistula. Lower cure rates were shown with increasing number of previous repairs. Recurrent fistulae after our repair were not statistically different in site and number in both groups. Nevertheless, fistulae after trimming tends to get larger than the original ones as compared to the non-trimming group which tends to get smaller. This is statistically different. Conclusion: Although there is no statistically significant difference between both groups regarding the cure rate in both fresh cases or recurrent ones, there is an advantage of not trimming the fistula since trimmed fistula tends to get larger, should recurrence occur after trimming. © 2011 Wiley-Liss, Inc.