Vesico vaginal fistula is a tract between the bladder and the vagina. As these organs are situated very near to each other any injury or disease caused to one of these organs can lead to the formation of a fistula. Usually vesico vaginal fistulas are formed consequent to surgeries to bladder or uterus or as a result of prolonged labor. Incontinence of urine is the common symptom of vesico vaginal fistulas. In some cases it is found that these fistulas may heal spontaneously by the continuous usage of catheter for passing of urine. If such fistula is not healing naturally it has to be closed by surgical methods. If it is a small fistula near the vaginal tract, it can easily be closed through vagina. But open surgery is usually carried out if the fistula is a high one.
Laparoscopic procedure
Advent of keyhole surgery technique has paved the way for carrying out the surgery relating to vaginal fistula also in a laparoscopic procedure. The important benefit of this procedure is that only four small incision of the size 5 mm to 10 mm are needed in this method to complete the surgical procedure.
Benefits of laparoscopic procedure
Laparoscopic procedure has the benefit that it makes the visualization of the fistula easier by the use of laparoscopic telescope and the special operating devices can easily be guided into the pelvis. But in open surgeries some difficulties are experienced as the depth of the operating field is larger and as there is less operating space in the pelvic region. This is very easier in laparoscopy as the devices and laparoscope can be guided to anywhere, through the abdomen. 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, IVC, CT/MRI scan etc are carried out to visualize internal organs like ureter, bladder and kidney. A completed medical checkup will also be done to study the general health condition of the patient and to study whether he has any problems relating to anesthesia. 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
After completing the surgery the patient will be brought to the recovery room where he will be under intensive care. One person will be allowed to meet the patient in this ward. A urinary catheter will be connected to make the urine passage easier. Another drain pipe will be there to remove the fluids from the surgical site. This drain will be taken out through a 5 mm hole. On the first post operative day the patient will be able to sit up and will feel little pain only. The patient is not expected to eat or drink anything on this day. On the second day the catheter in the water passage will be removed and semi-solid food is allowed on this day which can slowly be converted to normal diet. The drain through the wound usually stops by the fourth day and it will be removed on the fifth day. On the sixth day the patient will be discharged and the suprapubic catheter will still be there. After one month the patient will be readmitted for removing this catheter. Before readmission outpatient visit will be necessary for urine culturing.
