LAPAROSCOPY IN UROLOGY
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LAPAROSCOPIC VESICO VAGINAL FISTULA REPAIR
Vesico vaginal fisutla is an abnormal communication between the bladder and the vagina. As the two organs are lying adjacent to each other any injury or disease that involves the the two organs at the adjacent walls can result in this condition. It is therefore commonly associated with prolonged labour, after surgeries to the uterus or bladder.
The symptoms one experiences is continuous incontinence of urine.
Occasionally by a prolonged period of continuous catheter drainage of the bladder, the fistula may heal spontaneously. If not it has to be closed surgically. If it is a small fistula, near the vaginal orifice, this can be done through the vagina. If it is a high fistula, the repair has to be by opening the abdomen.
However the same operation can be done Laparoscopically through 4 key holes. Laparoscopy affords easier visualization of the fistula and its repair due the fact that the laparoscopic telescope and the operating instruments can easily be directed into the pelvis. In open surgery, due to the depth of the operating field and lack of space within the pelvis, difficulties are encountered during repair. As fat (omentum) from the intestines is required to be placed between the bladder and the vagina, a large abdominal incision is required for open surgery. This is not required for laparoscopy, as the telescope and instruments can be directed to anywhere in the abdomen.
As the internal and external wounds are smaller in laparoscopy as against open surgery, post operative pain and recovery are very much less after laparoscopic repair. However, the operating time is 50% more in laparoscopy and requires above average skills in suturing and dissection.
PRE OPERATIVE INVESTIGATIONS.
The extent of the fistula has to be clearly defined before repairing. This will involve a special X-ray, IVU,CT or MRI to visualize the kidney, its tubes to the bladder and the bladder. A telescope examination of the bladder (Cystoscopy) and peroperative Xray visualization of the ureters (RGP) is required before repair is undertaken . This can sometimes be done as the preliminary step at the time of the laparoscopic surgery.
A complete general medical check up is also done before the laparoscopic surgery.
DAY BEFORE SURGERY
DAY OF SURGERY
1ST POSTOPERATIVE DAY
2ND POST OPERATIVE DAY.
5th POST OPERATIVE DAY
6th POST OPERATIVE DAY.