Boari Procedure (Laparoscopic)

BOARI procedure is done to treat Vesicovaginal fistula.


3 hr : 00 min

5

14


vesico vaginal fistula

“Vesico” refers to the urinary bladder and the Vagina is the tubular canal that is a part of the female reproductive system, which extends from the womb to the exterior of the body. A Vesico vaginal fistula is an abnormal tract that is created between the urinary bladder and the vagina; Similarly, a uretero vaginal fistula extends between a defect in the ureters and the vagina. Both these cause urine to leak through the vagina.

Understanding boari

The urinary tract is at risk of injury during pelvic operations and complicated child birth. Such injuries may lead to fistula formation, whereby the urine involuntarily leaks through vagina/birth canal. This is a very embarrassing situation for females. So once identified, early treatment is recommended. Initially, when this condition happens immediately after child birth or after a surgical procedure, A tube(catheter) may be inserted to temporarily drain the urine. During this time, the defect or fistula heals automatically. In case this intervention fails, laparoscopic repair is advised. The aim of the repair is to destroy this connection between the bladder or ureter and vagina and seal the defect on the organ, so that the tract doesn’t form again. A Laparoscopic Boari procedure is the name given to repair such a defect on the ureters.

Laparoscopic Boari procedure was first described in 2001 by Fugita et al. This procedure can also be done to operate on ureteral cancer.

How is boari procedure Performed

Through one or more small holes made in the abdomen, the surgeon accesses the abdomen.

The fistula tract between the ureter and vagina is identified. This tract is disrupted using heat.

Then the  ureter from which the fistula begins is identified and is cut right above the defective portion.

Since the cut ureter will be shorter, a tongue like structure is created from the bladder itself. This is lifted upwards and wrapped around the remaining part of the cut ureter.

A stent is then placed inside the ureter to prevent it from collapsing.

A drain is placed to remove excess blood from the operated site and a catheter (hollow tube) is placed to drain the urine temporarily.

Catheter and drain are removed in 2 days, the stent in 6 weeks.

flap creation in Lap boari procedure

Treatment window

It is a socially embarrassing situation for women when urine leaks out through the vagina. Moreover, they will be prone to vaginal and urinary tract infections. Hence early treatment calls for a better quality of life.

Life after boari procedure

The woman can return to normal activities 2 weeks after surgery. However, follow up check ups will be advised by the surgeon for stent removal and to confirm proper healing of the area were surgery was performed.

boari procedure FAQ

This is an abnormal communication between the vagina (usually it is just the blind end of the vagina after a hysterectomy) and bladder.

This can be a sickeningly difficult problem for a patient, with continuous leak of urine through the vagina. As the vagina has no sphincter to control it, the patient will be wetting her underclothes constantly, that she will smell like a mobile urinal, This is one of the most troublesome problems for a woman, after a hysterectomy.

During the course of a difficult hysterectomy, there might be a small injury to the bladder. Later this communicates and forms a tract to the vagina. The established tract is known as the vasico vaginal fistula.
The patient will usually diagnose this! When after hysterectomy, the patient sees the continuous flow of urine; she usually puts to and to together and will actually tell the doctor that she has a communication.
A simple methylene blue test is describe in which a dye is put into the bladder, which then stains the vagina and proves that there is a communication.
We sometimes do a contrast study (CT Scan) to make sure that there is no communication from the tube above(ureter to the vagina), etc.
No. Unfortunately not. Almost all vesicovaginal fistulae, after diagnosis will need a surgical correction and a repair.
Either through the vagina from below or with a cut from above or with a laparoscope from above, the tract between the vagina and bladder is dissected, interrupted and bladder and vaginal cavities are closed separately.
Also a little bit of fat is brought from above to plug the gap between the 2 organs to prevent the tract from forming again.
Yes. Although it is a very difficult procedure, we will not guarantee that the complete procedure can be done through a keyhole. We have been extremely successful on a few occasions for a keyhole correction of vasico vaginal fistula.

boari procedure Specialists

Dr. J. S. Rajkumar

CHIEF SURGEON

M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)


Dr. Ilamparuthi Chennakrishnan

GENITO- URINARY SURGEON
M.B.B.S., M.S. (General surgery), M.Ch. (Urology), D.N.B. (GUS), F.I.C.S.