Interposition flaps in transabdominal vesicovaginal fistula repairs: Are they really necessary?

Objectives. To evaluate the use of interposition flaps in repairing vesicov aginal fistulas (VVFs) of benign and malignant etiologies. Interposition fl aps are not routinely used in the repair of VVFs when the surrounding tissu es appear healthy and well-vascularized, such as in a benign etiology. Methods. We retrospectively reviewed the charts of 37 women (mean age 49.1 years) at our institution who underwent transabdominal repair of their VVF by urologic surgeons between August 1978 and June 1999. The preoperative an d postoperative medical records were reviewed. Results. Of the 37 VVFs repaired transabdominally, 29 had a benign etiology (25 related to gynecologic procedures) and 8 a malignant etiology (all rel ated to gynecologic neoplasia). Of the 29 benign VVFs, an interposition fla p was used in 10 repairs with all 10 successful (100%). The remaining 19 be nign VVF repairs were performed without using a flap, with 12 successful (6 3%). Of the 8 malignant: fistulas, an interposition flap was used in 2 repa irs with both successful (100%). The remaining 6 malignant VVF repairs were performed without a flap, with 4 successful (67%). Conclusions. The results of our study indicate a higher success rate for tr ansabdominal VVF repairs performed with an interposition flap (100% success rate at our institution). This observation holds true regardless of the ap pearance of healthy surrounding tissue or, more importantly, a benign or ma lignant etiology. We recommend interposition flaps in transabdominal repair s of VVFs, even in the cases of benign fistulas with well-preserved surroun ding tissue. UROLOGY 57: 670-674, 2001. (C) 2001, Elsevier Science Inc.