ttelo1.gif (1393 bytes) 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

  • Admission is done and laxatives are given to cleanse the bowel and vaginal douche given to cleanse the vagina.

DAY OF SURGERY

  • After surgery you will be in the postoperative ICU.

  • One person can visit you immediatly after surgery in the post operative ICU.

  • You will have a catheter in the water passage and another catheter into the bladder below the umbilicus. A drain tube will also be there to drain the repair site. This tube will be taken out through one of the operating 5 mm key holes.

1ST POSTOPERATIVE DAY

  • Transferred from the ICU to the room. Can walk to the toilet and will be able to sit up with very little pain.

  • Should not have anything to eat or drink.

2ND POST OPERATIVE DAY.

  •  Removal of the catheter in the water passage and allowed to have semisolid and later normal diet - as advised by your surgeon..

5th POST OPERATIVE DAY

  • The drainage through the drain usually stops by 4rth postoperative day and the drain can then be removed today.

6th POST OPERATIVE DAY.

  • Usually discharged today with the suprapubic catheter. To be re- admitted after 1 month from the date of operation for catheter removal. Outpatient visit is required before re-admission for a urine culture.