Performed for urinary incontinence following obstetric injury or hysterectomy in the past. Patient complaints of constant bed wetting after surgery.
Incidence of obstetric injury or hysterectomy operation had reported sometime with vesico vaginal fistula with constant bed-wetting. At least six weeks should be allowed after primary surgery before VVF repair to reduce tissue edema. Kidney function, USG, IVP and Cystoscopy should be performed before VVF repair for the evaluation of the case & surgical planning of VVF repair.
Benefits of Laparoscopy Surgery:
- Shorter Hospital stay.
- Earlier return to your routine work.
- Cosmetically vary small scar.
- Less pain after operation.
- Best fertility enhancement & Fertility results following Laparoscopy.
- Video-live operative file available in CD/DVD for future reference (Transparency about surgical procedure).
- The possibility of post-operative adhesion formation will be less, and the possibility of pain because of post-operative adhesions will also be less.
- Special advantages of laparoscopic VVF repair are:
- Better pain relief after operation.
- Less chances of redo surgery again.
- Comprehensive and anatomical repair of bladder defect repair better.
Pre-operative Check Lists:
- Lab. Investigation for Surgery (Urine complete & Blood complete, HbsAg, HIV, R.B.S., Pelvic Trance vaginal USG report, Bl.urea, IVP, Cystoscopy etc.
- Specific Investigations for associated problems.
- Operation planned after good vaginal mucosa support before planning surgery.
- Two days of liquid diet before operation and Special Peglac / Colo-wash (Powder dissolved in one liter of drinking water and patient is asked to drink every 10 minutes till the same colored fluid comes out instead of stool) six hours prior to operation & preparation/shaving of local parts.
No. Of Cuts on Abdomen:
Three cuts: all of 5 mm size.
Average Stay in Hospital:
12-24 hours. (DAY CARE SURGERY)
Average Duration of Surgery:
Average Blood loss during Surgery:
Average time after operation to resume normal activities/work:
Within 24 hours.
General Anesthesia (Patient will not feel any pain in Operation Theatre during surgery)
Inside the Umbilicus small needle is introduced and Co2 gas is insufflated inside abdomen. Rather than creating a large incision and opening up the body, tiny incisions are made and a laparoscope is inserted. This slim scope has a lighted end. It takes pictures – actually fiber optic images - and sends them to a monitor so the surgeon can see what is going on inside.
Performing laparoscopy usually only requires three tiny incisions less than one half inch, (about 5-10 millimeters) in length. With previous midline scar on abdomen, we generally introduce verres needle through palmer’s point and then first 5 mm port is introduced through Palmer’s point. This allows the surgeon a better view and more working space to maneuver the laparoscope and surgical tools as needed. Using small incisions rather than opening the abdomen lessens recovery time as well as discomfort and makes surgical scars less noticeable. With help of palmer’s point port, second 5 mm port is kept supra umbilically on vision above the midline intra abdominal midline adhesions. Third port is kept on Rt side near anterior superior iliac spine on vision. Adhesiolysis is done with Bipolar & scissor and adhesions are stretched from one side simultaneously
Cystoscopy done and both ureters are catheterized. Peritoneum near bladder and vagina is identified laterally and gently dissected. For difficult case bladder can be filed with saline and bladder boundaries identified. Area surrounding fistula tract is dissected towards vagina.
Most of the time many patients undergo laparoscopy as Day care procedure, returning home within 24 hours of surgery. For normal laparoscopy procedure takes about 15 to 35 minutes only. For more complicated case it may take 1-2 hour. Most begin feeling much better within one day.
- Patient remains drowsy/sedated for 2-3 hours after laparoscopy but conscious & pain free.
- Patient can take fluids 6-8 hours after laparoscopy & light food after 8-10 hours.
- She may feel little abdominal & shoulder pain after laparoscopy for 24 hours but it cam be relived with pain killer tabs.
- Most of the patients can walk normally without support and can take normal diet 12hours after the laparoscopy.
- Folly’s catheter is removed on next day. She can be discharged on the next day of the operation.
- Few patients may feel nausea & vomiting after laparoscopy, which can be very well controlled with injection in post-operative room.
- Patient can do her normal activity within 24 hours after laparoscopy. Patient is advised to take antibiotics & analgesic tabs. for 5 days following laparoscopy.
- Patient is advised to report to doctor for severe pain or bleeding or fever in postoperative period (Day-1 to Day-5) immediately.
- Patient is advised to come for follow up 7 days after the Laparoscopy for dressing.