Lack of value of the Martius fibrofatty graft in obstetric fistula repair

Objective: To ascertain if the Martius graft is of benefit to successful surgical outcome in obstetric fistula repair. Method: A retrospective analysis of 440 consecutive obstetric fistula repairs performed by the author in the Addis Ababa Fistula Hospital, Ethiopia or the Barhirdar Hamlin Fistula Center, Ethiopia, with or without the Martius fibrofatty graft. These were further divided into 13 subgroups of vesicovaginal fistula and all groups compared against two outcomes; fistula closure and presence of residual urethral incontinence following repair. Results were statistically analyzed with the Fisher's exact or Chi-squared test. Results: There was no statistical difference between groups with regards to breakdown of repair but a higher rate of residual incontinence in 3 subgroups with the Martius graft. Conclusion: The Martius graft can be safely omitted from obstetric fistula repair if the surgeon is experienced, and performs the same type of repair as used in this analysis.