Is tissue interposition always necessary in transvaginal repair of benign, recurrent vesicovaginal fistulae?

Objective: To evaluate and compare the outcomes of transvaginal repair of benign, primary, and recurrent vesicovaginal fistulas (VVFs) treated without tissue interposition because, historically, tissue interposition with a vascularized flap has been advocated in both transabdominal and transvaginal repairs of recurrent VVFs. Methods: A retrospective chart review was conducted of 73 consecutive women with VVF and treated by a single surgeon (B.J.F.) between January 2003 and May 2012. Patients with a malignant etiology and/or prior irradiation were excluded as they required a more complex repair. All included VVFs were treated by a transvaginal approach with partial vaginal cuff excision without a tissue interposition. Patients were followed in our clinic postoperatively for 1 year and by telephone survey thereafter. Results: Forty-nine patients met inclusion criteria: 25 primary and 24 recurrent. There was no statistical difference in patient age, fistula size, time to repair, or fistula etiology between the 2 groups. There has been no fistula recurrence in either group. Forty-one of 49 patients (84%) were discharged the same day as their surgery. Conclusion: Benign, recurrent VVFs are not synonymous with other complex fistulas that typically require tissue interposition. Our study demonstrates that transvaginal repair of benign, recurrent VVFs without tissue interposition can be equally successful as primary repairs without tissue interposition. The number of prior repairs should not be an independent factor in the use of tissue interposition, as previously suggested. We advocate an individualized approach to each VVF, only using tissue interposition when appropriate.