Transabdominal open repair of Vesicovaginal fistula: A large single-center experience from Bangladesh in the era of minimally invasive surgery

Abstract

Vesicovaginal fistula (VVF) remains a profoundly debilitating condition, particularly in low- and middle-income countries where obstetric complications continue to be the predominant cause. Although minimally invasive surgical techniques have gained increasing popularity, open transabdominal repair retains an essential role, especially for complex fistulas. To evaluate the outcomes of open transabdominal VVF repair and to identify independent predictors of surgical failure in a large cohort treated at a tertiary referral center in Bangladesh. This retrospective cohort study included 126 patients who underwent open transabdominal VVF repair at Bangladesh Medical University between January 2006 and November 2024. Demographic data, fistula characteristics, etiology, duration of fistula and history of previous repair were analyzed. Surgical success was defined as complete fistula closure without urinary leakage at 3 months follow-up. Univariate analyses were performed using Fisher’s exact test and multivariable logistic regression was used to identify independent predictors of repair failure. The mean age was 34.8 ± 8.6 years. Obstetric etiology accounted for 77.8% of cases, and 18.3% had undergone previous failed repairs. Most fistulas were single-tract (81.0%), while 35.7% measured ≥3 cm. The overall success rate was 90.5% (114/126). On multivariable analysis, fistula size ≥3 cm (adjusted OR 18.6, 95% CI 2.2–156.8; p=0.007) and previous failed repair (adjusted OR 9.3, 95% CI 1.7–50.4; p=0.011) were independent predictors of failure. Multiple tracts were not independently associated with failure. Postoperative complications were infrequent and mostly minor. Open transabdominal VVF repair achieved a high success rate in a challenging patient population. Larger fistula size and prior failed repair independently predicted failure. This approach remains a safe, effective, and indispensable option for complex VVFs, particularly in resource-limited settings.