title: Comparative analysis of outcome between open and robotic surgical repair of recurrent supra-trigonal vesico-vaginal fistula.
abstract: BACKGROUND
  Recurrence of fistula is one of the very common complications of fistula repair. The disease has immense psychosomatic effect on the patients due to continuous leakage of urine. Management of recurrent vesico-vaginal fistula (VVF) repair poses a challenge to surgeons.
  
  
  METHODS
  Group I-12 patients with recurrent VVF, having robotic repair from August 2006 to June 2008, were included in the present study. Group II-20 patients matched in all possible parameters with recurrent VVF having open surgical repair in the past were taken as controls. Patients in both the groups were evaluated by assessing relevant clinical details; performing urine routine examination and culture, renal function test, three swab test, ultrasonogram-kidney, ureter, and bladder radiograph, intravenous urogram (to look for upper tract and rule out uretero-vaginal fistula), and urethro-cystoscopy. The details were retrospectively recorded from the case sheets.
  
  
  RESULTS
  In group I, 100% were successfully managed as compared with 90% in group II, but it was not statistically significant (p > 0.05). Mean blood loss was significantly less (p < 0.05) in group I compared with group II (mean 88 vs. 170 mL). The mean hospital stay also was significantly less (p < 0.05) in group I in comparison with group II (mean 3.1 vs. 5.6 days). None of the patients had complications in group I compared with group II, but it was not significant.
  
  
  CONCLUSIONS
  The present study suggests that robotic VVF repair is a better option for recurrent fistulas in view of its reduced morbidity, without compromising the results.
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Narmada P
authors.initials: NP
authors.lastname: Gupta
authors.forename: Saurabh
authors.initials: S
authors.lastname: Mishra
authors.forename: Ashok K
authors.initials: AK
authors.lastname: Hemal
authors.forename: Archana
authors.initials: A
authors.lastname: Mishra
authors.forename: Amlesh
authors.initials: A
authors.lastname: Seth
authors.forename: Prem N
authors.initials: PN
authors.lastname: Dogra
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D005260:Female; D006801:Humans; D008875:Middle Aged; D012008:Recurrence; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome; D014719:Vesicovaginal Fistula / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult