Perioperative Outcomes of Vesicovaginal Fistula Repair by Surgical Approach

<jats:sec> <jats:title>Importance</jats:title> <jats:p>Data comparing perioperative outcomes between transvaginal, transabdominal, and laparoscopic/robotic vesicovaginal fistula (VVF) repair are limited but are important for surgical planning and patient counseling.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective</jats:title> <jats:p>This study aimed to assess perioperative morbidity of VVF repair performed via various approaches.</jats:p> </jats:sec> <jats:sec> <jats:title>Study Design</jats:title> <jats:p>The American College of Surgeons National Surgical Quality Improvement Program database was used to identify women who underwent transvaginal, transabdominal, or laparoscopic/robotic VVF repair from 2009 to 2020. Associations of surgical approach with baseline characteristics, blood transfusion, prolonged hospitalization (>4 days), and 30-day outcomes (any major or minor complication or return to the operating room) were evaluated with χ<jats:sup>2</jats:sup>, Fisher exact, and Kruskal-Wallis tests. Multivariable logistic regression models assessed the adjusted association of approach with 30-day complications and prolonged hospitalization.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Overall, 449 women underwent VVF repair, including 252 transvaginal (56.1%), 148 transabdominal (33.0%), and 49 laparoscopic/robotic procedures (10.9%). Abdominal repair was associated with a longer length of hospitalization (median, 3 days vs 1 day transvaginal and laparoscopic/robotic; <jats:italic toggle="yes">P</jats:italic> < 0.001), higher risk of prolonged length of stay (abdominal, 21.1%; transvaginal, 4.0%; laparoscopic/robotic, 2.0%; <jats:italic toggle="yes">P</jats:italic> < 0.001), major complications (abdominal, 4.7%; transvaginal, 0.8%; laparoscopic/robotic, 0.0%; <jats:italic toggle="yes">P</jats:italic> = 0.03), and perioperative transfusion (abdominal, 5.0%; transvaginal, 0.0%; laparoscopic/robotic, 2.1%; <jats:italic toggle="yes">P</jats:italic> = 0.01). On multivariable analysis, the abdominal approach was independently associated with an increased risk of prolonged hospitalization compared with laparoscopic/robotic (odds ratio, 12.3; 95% confidence interval, 1.63–93.21; <jats:italic toggle="yes">P</jats:italic> = 0.02) and transvaginal (odds ratio, 6.09; 95% confidence interval, 2.87–12.92; <jats:italic toggle="yes">P</jats:italic> < 0.001) but not with major/minor complications (<jats:italic toggle="yes">P</jats:italic> = 0.76).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Transvaginal and laparoscopic/robotic approaches to VVF repair are associated with lower rates of prolonged hospitalization, major complications, and readmission compared with a transabdominal approach.</jats:p> </jats:sec>