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Perioperative Management of Patients with Colovesical Fistula
Scott C Dolejs1, Alyssa J Penning1, Michael J Guzman1
1Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
Summary
Routine intraoperative bladder leak testing is recommended for colovesical fistula (CVF) surgery. Postoperative bladder leaks are uncommon and resolve without reoperation, suggesting shorter catheter use may be considered.
Area of Science:
- Surgical Management
- Gastroenterology
- Urology
Background:
- Colovesical fistula (CVF) is a rare complication of diverticulitis.
- Significant variation exists in the perioperative management of CVF.
- This study evaluates key perioperative interventions for CVF.
Purpose of the Study:
- To assess the utility of intraoperative bladder leak testing.
- To evaluate the role of closed suction drainage and prolonged bladder catheterization.
- To determine the effectiveness of routine postoperative cystograms in managing CVF.
Main Methods:
- Retrospective study of 89 patients undergoing operative repair for diverticular CVF.
- Analysis of perioperative management strategies including bladder leak testing, drainage, catheterization, and cystography.
- Review of outcomes including mortality, morbidity, and postoperative urinary leaks.
Main Results:
- Overall mortality was 4% and morbidity was 46%.
- Intraoperative bladder leak tests identified 11% of leaks, with no leaks occurring in patients with negative tests.
- Postoperative bladder leaks occurred in 6% of patients, diagnosed between postoperative days 3-7, and resolved within 2 months without reoperation.
Conclusions:
- Routine intraoperative bladder leak testing is advisable for CVF surgery.
- Routine postoperative cystograms have low diagnostic yield and may increase costs.
- Early urinary catheter removal (before postoperative day 7) should be considered.
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