Comparison of Success Rates in Transabdominal Vesicovaginal Fistula Repair With and Without Omental Flap Interposition: A Retrospective Cohort Study.

Introduction Vesicovaginal fistula (VVF) is an abnormal communication between the urinary bladder and vagina, resulting in continuous urinary incontinence. Common causes include iatrogenic injuries during obstetric and gynecological surgeries, pelvic malignancies, and radiotherapy. Objective To compare the success rate of transabdominal VVF repair performed with and without interposition of a pedicled omental flap. Methodology This retrospective study was conducted at Sir Ganga Ram Hospital, Lahore, Pakistan, by reviewing medical records from August 2023 to August 2025. A total of 60 patients with VVF were included. Patients were divided into two groups based on the surgical technique performed: those who underwent repair with an interposition omental flap (Group A, n=30) and those who underwent repair without an interposition omental flap (Group B, n=30). Treatment success was defined as complete fistula closure without urinary leakage, assessed at three months postoperatively. Results Successful closure was achieved in 29/30 (96.7%) patients in the Group A compared to 22/30 (73.3%) in the Group B (χ²=6.38, p=0.011). Age did not significantly influence treatment outcomes. However, fistula size and operative duration were significantly associated with surgical success. Large-sized fistulae in the Group B were associated with lower success rates (χ²=16.20, p=0.001), and procedures lasting >120 minutes had reduced success in the Group B (χ²=6.44, p=0.011). Conclusion The use of an interposition omental flap significantly improves the success rate of transabdominal VVF repair. Incorporating a vascularized omental graft enhances surgical outcomes and reduces failure rates.