Use of fibrin glue versus martius flap interposition in Trans-vaginal vesicovaginal fistula repair: A prospective randomized trial.

INTRODUCTION

In vesicovaginal fistula repair, studies have shown the utility of fibrin glue as interpositioning layer. Our goal in this study is to determine the effectiveness of fibrin glue as an interpositioning layer versus martius flap interposition and primary healing alone.

MATERIALS AND

METHODS

We prospectively analyzed 64 patients over a period of 24 months from February, 2023 to January, 2025 and divided them as group-A in which fistulas were repaired anatomically using fibrin glue interpositioning, group-B in which fistulas were treated using only primary repair and group-C in which Martius flap was used during anatomical surgical repair as an intervening layer between the vaginal repair and bladder repair. The measured data included operative time, length of hospital stay, leak free status at POD 21, PISQ-12 (Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire) questionnaires and post-operative complications.

RESULTS

The operative time was minimum in Group-B as compared to Group-A & C. (Group-A [183.64 ± 13.46 min.], Group-B [163.33 ± 14.60 min.] & Group-C [218.57 ± 24.75 min.]) which was significant (p = 0.000). The mean post operative hospital stay was minimum in Group-A, which were 7 ± 0.92, 8.19 ± 0.75 and 7.62 ± 0.74 days in A, B, and C groups (p = 0.01), respectively. Leak free status at POD-21 days after removal of catheter was comparable in Group-A & Group-C (Group-A was 90.9% vs 81% in Group-B vs 90.5% in Group-C) (p = 0.541). PISQ-12 in Group-A was 23.23 versus 23.76 in Group-B versus 22.14 in Group-C and which was significant (p = 0.002).

CONCLUSIONS

The study revealed that interposing layer in the form of glue is not an inferior option when compared to primary repair alone and martius flap as the total operative time, need for hospital stay and leak free status was comparable with lesser complications and comorbidities.