World class hospitals offering fistula repair surgery in India-video

Fistula repair surgery in India is performed at world class hospitals that are attracting many patients from across the world. The reason for the global appreciation is the availability of less cost options. Another reason for the global appreciation of fistula repair surgery in India is because it is performed under the supervision of renowned surgeons. Many patients come to India to get their treatment at advanced Indian hospitals. Indian medical tourism is earning great reputation for its world class facilities at an affordable cost budget and assisting its abroad patients well.

A fistula is an abnormal tunnel connecting two body cavities (such as the rectum and the vagina) or a body cavity to the skin (like the rectum to the outside of the body). One way a fistula may form is from an abscess - a pocket of pus in the body. The abscess may be constantly filling with body fluids such as stool or urine, which prevents healing. Eventually the fistula breaks through to the skin, another body cavity, or an organ. Fistulas are more common in Crohn's disease than in ulcerative colitis.

Symptoms of fistula

• Pain
• Fever
• Tenderness
• Itching feeling in vagina and generally feeling poorly.

Causes of fistula

• Caused during child birth
• Prolonged labor
• Cutting off blood flow to the vesicovaginal wall

Types of fistulas

• Enterocutaneous: This type of fistula is formed from the intestine to the skin. It can be described as a passageway that progresses from the intestine to the surgery site and then to the skin.
• Enteroenteric or Enterocolic: This is a fistula that involves the large or small intestine.
• Enterovaginal: This is a fistula that goes to the vagina.
• Enterovesicular: This type of fistula goes to the bladder.

Procedure

In this video before the fistula repair surgery the patient is placed in the dorsal lithotomy position for adequate exposure of the fistula. A large mediolateral episiotomy is frequently required and should be carried up to the area of the fistula. With adequate exposure the fistula tract can be excised with a scalpel. In the fistula repair surgery the incision is carried around the circumference of the fistula. The margin of the fistula tract is elevated with thumb forceps and excised with metzenbaum scissors. The entire tract is dissected. The layers of the bladder wall and vagina should be adequately delineated, and each of these layers should be mobilized to allow the layers to be drawn together with fine sutures. The bladder mucosa is identified and closed with interrupted synthetic absorbable suture in the submucosal layer. Using a second layer, the bladder muscle, is closed with synthetic absorbable suture. The bladder muscle is completely closed over the fistula area with interrupted synthetic absorbable suture. At this point an external blood supply for the fistula site is needed. This can be given from the bulbocavernosus muscle from beneath the labia majora, or from the vaginal canal, the gracilis muscle from the leg or the rectus abdominis muscle that can be brought in to cover the fistula site.

If the bulbocavernosus is selected, two incision sites are made. One is on the inside of the labia minora. The other is down the body of the labia majora. If the latter incision is selected, the bulbocavernosus muscle must be tunneled under the labia minora into the episiotomy wound. Clamps are used for retraction of the labia, and a scalpel is used for dissection down to the bulbocavernosus muscle. It is important to enlarge the incision in the fistula repair surgery, so that the entire muscle can be visualized. The bulbocavernosus muscle is identified and mobilized. Frequently, at the level indicated here, the branches of the pudendal artery and vein enter the muscle and may have to be clamped and ligated for hemostasis. The bulbocavernosus muscle should be mobilized by blunt and sharp dissection up to the level of the clitoris and transected at its insertion in the perineal body. If the initial incision has been made on the inside of the labia minora, no tunneling of the bulbocavernosus muscle is needed, and the muscle is swung into position, covering the fistula site. It is sutured to the perivesical tissue with interrupted synthetic absorbable sutures. In the fistula repair surgery if the initial incision has been carried over the labia majora, a tunnel is created with a kelly clamp under the labia minora into the episiotomy incision. The bulbocavernosus muscle is pulled through this tunnel, applied to the fistula site, and sutured into place with interrupted synthetic absorbable suture. The vaginal mucosa must be mobilized for closure without tension. Generally, the wound is closed with interrupted synthetic absorbable suture. The vaginal incision, the episiotomy incision, and the incision for the bulbocavernosus muscle transplant are closed. A foley catheter is inserted through the urethra. After fistula repair surgery, the bladder is generally filled with approximately 200 ml of methylene blue or sterile milk solution to ascertain if the fistula is completely closed.

Complications associated with fistula repair surgery

• Post operative failure
• Recurrent fistula formation
• Injury to bowel, intestine or ureter
• Vaginal shortening

Hospitals in India providing fistula repair surgery are rapidly gaining ground in the international scenario as a popular destination for foreign travelers, international students for migrating to this mystical land for health and medical tourism. Medical tourism is also giving a helping hand to the patients who want to get their fistula repair surgery done in India with the best lodging and medical care amenities at Indian hospitals and clinics.

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