Laparoscopic procedure

With advancement in technology of keyhole surgery it s possible to carry out difficult reconstructive work like vesico vaginal fistula closure. The important benefit of this procedure is that only four small incision of the size less than 1 cm needed method to complete the surgical procedure.

Benefits of laparoscopic procedure
Laparoscopic procedure has the benefit that it makes the visualization of the inside structures easier. Once abdomen is distended with gas, a camera is introduced in one of the holes. The vision in camera is magnified and we can take the camera into areas which are difficult to be visualized by naked eye during open procedures. As the incisions are smaller the pain will be lesser and the healing of the wound will be faster and the patient will be able to return to his routine activities at an early date as quicker recovery is possible in this surgical procedure. However the operating time needed in laparoscopic procedure is 50 % more than in open surgery and the surgery fee may also be little extra. But the overall expenditure and strain will be lesser as the hospital stay is lesser and recovery is faster.

Pre operative preparations
Before starting to repair the fistula the extent of the fistula has to be clearly understood. For this purpose special X-rays, IVU, CT/MRI scan etc are carried out to visualize internal organs like ureter, bladder and kidney. A preoperative , cystoscopy, vaginoscopy will also be done to assess the size of fistula, number of fistulas, to rule out uretero vaginal fistula which present with similar symptoms. A complete medical checkup will also be done to study the general health condition of the patient. General health check up is to confirm a good fitness level to with stand anaesthesia. The patient will be admitted to the hospital on the day before the surgery. Bowel will be cleansed using laxatives and vagina will be cleansed using vaginal douche.

Post operative care

The patient will be shifted to postoperative ICU immediately after recovery from anaesthesia. One person will be allowed to meet the patient in the ICU. Observation in ICU will last from six hours- 12 hours depending on the length of the surgery and patient condition immediately after surgery. There will be a urinary catheter placed for draining urine. Patient will be allowed to eat or drink only after his bowel sounds resume. It might take 12 hours to 36 hours for bowel to start peristalsis following laparoscopy. Patient will be made to situp and slight mobilization from six hours following recovery. Patient will be discharged once he/ she is tolerating orally and passing stools. This might take four days to one week. Patient will be readmitted for catheter removal and to assess how they are voiding after catheter removal and to check for any leaks.