The cost effectiveness of vaginal versus abdominal repair of vesicovaginal fistulae

Abstract

Introduction and hypothesis The objective was to assess the comparative provider costs of vaginal and open abdominal repair of vesicovaginal fistula (VVF) and to determine the most cost-effective means of managing VVF. Methods A prospectively acquired database of all women undergoing VVF repair by a single surgeon between 2007 and 2015 was retrospectively reviewed to determine operating time, perioperative complications, inpatient stay and 30-day readmissions. The success and cost of the VVF repair were identified. Statistical analysis was by unpaired t test, Chi-squared test and Mann-Whitney U test. Results Forty-seven consecutive women of mean age 51 years (range 21-88) undergoing a first attempt at VVF repair at our institution were included; 32(68%) had vaginal repair with Martius fat pad interposition and 15 (32%) had open abdominal repair with omental interposition. There were no perioperative complications or 30-day readmissions in either group. Mean operative time was longer for open abdominal (223.4 min) than vaginal repair (196.9 min). Median inpatient stay was longer for an open abdominal (8 days) than for a vaginal approach (4 days). Successful anatomical closure was achieved in 91% of vaginal and 86% of open abdominal repairs at first attempt, and in 100% after second repair, where required. Mean/median costs for an abdominal repair were significantly higher, at £4,608.69/£4,169.20 than for vaginal repair at £3,381.50/£3,009.24 (P < 0.05). Conclusions Vesicovaginal fistulae were successfully repaired in 89% of cases at first attempt. The success rate did not differ between approaches. Vaginal repair is significantly more cost-effective than abdominal repair owing to the shorter operative time and length of stay.

Comparison the Success Rate of Vesicovaginal Fistula Repair Surgical With Transvaginal and Transabdominal Procedure : Meta Analysis

“…The disadvantages of TPA were post-operative pain, temporary ileus, over bleeding, longer operating time, higher cost and longer length of stay. Notwithstanding with all of those evidences based on the literatures which was reviewed in this study, there is no significant different success rate between TVAG and TPA 4,6,7,12 . In the study of Burak et al, 2017 it said that the range of success rate of VVF were 70-100% 11,13,14 , while the TPA was around 90-100% 14 .…”

“…Three of them are cross sectional 4,7,12 , one is a cohort study 6 . One study with prospective data, but reviewed as a retrospective 7 4). The accumulative data are 191 patients (transvaginal-n=107; transabdominal-n=84).…”

“…Complex and radiated type VVF are indicated for surgical repair. The expected outcome from these therapies are the closure lesion, better quality of life, and sexual functions 7 .…”

“…In the UK and developed world, Warner R et al suggests that vaginal repair is significantly more cost-effective than abdominal repair owing to the shorter operative time and length of stay with no significant difference in the success rates. 7 Tatar B et al researched that vaginal approach to VVF repair is more cost-effective because the mean hospitalization time is less compared with transabdominal repair, and this difference emphasizes the vaginal route as the first choice without compromising the success rate 4 . This paper aims to evaluate the success rate of vesicovaginal fistula (VVF) repair surgery by transvaginal (TVAG) and transabdominal (TPA) procedure.…”

“…It may appears a couple years after the therapy 6 . The others cause could be trauma and iatrogenic from obstetric, gynecologic, or urological surgery 1,7 . The patophysiology of VVF in obstetric trauma is an ischemic fibrous while having a labour.…”