Vesicovaginal fistula repair: comparative analysis of perioperative outcomes and predictors of success in open, laparoscopic, and robotic approaches

TL;DR

This study compares open, laparoscopic, and robotic surgeries for repairing vesicovaginal fistulas, finding that minimally invasive methods offer better perioperative outcomes but open surgery is better for complex cases.

Contribution

The study provides a comparative analysis of surgical approaches for vesicovaginal fistula repair, identifying predictors of success and perioperative advantages of minimally invasive techniques.

Findings

Minimally invasive techniques reduced operative time and blood loss compared to open surgery.

Post-hysterectomy fistulas had the highest success rate, while radiation-induced and trigonal fistulas had poorer outcomes.

Surgical approach was not an independent predictor of closure rates, but minimally invasive methods offered better perioperative results.

Abstract

To compare perioperative outcomes and evaluate predictors of successful repair in vesicovaginal fistula (VVF) cases among open, laparoscopic, and robotic-assisted approaches.

This retrospective cohort study included 78 patients who underwent transabdominal VVF repair between December 2015 and July 2024 at a tertiary referral center. Patients were categorized based on surgical approach: open (n = 31), laparoscopic (n = 31), or robotic-assisted (n = 16). Data collected included demographics, fistula etiology and location, prior radiation exposure, operative time, blood loss, use of interposition flaps, and 3-month postoperative closure status.

Minimally invasive techniques (laparoscopic and robotic) demonstrated reduced operative time (P = 0.014) and blood loss (P < 0.001) compared to open surgery. Time to repair (P = 0.001) and previous repair attempts (P = 0.007) varied significantly across approaches. Post-hysterectomy fistulas had the highest success rate (95%), while radiation-induced (P = 0.031) and trigonal fistulas (failure rate 32% vs. 6% in non-trigonal; P = 0.004) were associated with poorer outcomes. Use of interposition flaps was more frequent in open cases but did not independently predict success. The surgical approach was not an independent predictor of closure rates; however, minimally invasive techniques were associated with better perioperative outcomes.

This study highlights the importance of selecting the surgical approach based on fistula characteristics and clinical context. Minimally invasive techniques provided perioperative advantages, whereas open surgery remains essential for complex cases. Careful preoperative planning and well-informed clinical decision-making are crucial to optimize management. Further prospective, multicenter studies are warranted to confirm these findings and guide standardized best practices.

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