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Related Experiment Videos

Internal fistulas in diverticular disease.

R J Woods1, I C Lavery, V W Fazio

  • 1Department of Colorectal Surgery, Cleveland Clinic Foundation, Ohio 44106.

Diseases of the Colon and Rectum
|August 1, 1988
PubMed
Summary

Internal fistulas in diverticular disease, though uncommon, are treatable. Primary anastomosis is now the preferred surgical approach, demonstrating acceptable outcomes and reduced complications compared to staged procedures.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Colorectal Surgery

Background:

  • Internal fistulas are rare complications of diverticular disease, often presenting treatment challenges.
  • This study reviews surgical management of internal fistulas in diverticular disease patients over a 26-year period.

Purpose of the Study:

  • To analyze the incidence, types, and outcomes of surgical management for internal fistulas in diverticular disease.
  • To evaluate the efficacy and safety of primary anastomosis versus staged procedures for these complex cases.

Main Methods:

  • Retrospective review of 84 patients surgically treated for internal fistulas associated with diverticular disease (1960-1986).
  • Analysis of fistula types (colovesical, colovaginal, coloenteric, colouterine) and patient demographics.

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  • Comparison of operative management strategies, including resection anastomosis, Hartmann procedure, and staged approaches.

    • Main Results:

    • Colovesical fistulas were most common (65%), followed by colovaginal (25%).
    • Complications included wound infection (21%), enterocutaneous fistula (1%), and anastomotic dehiscence (5%).
    • A shift towards decreased use of staging procedures in the latter half of the series showed no significant increase in complications.

    Conclusions:

    • Primary anastomosis is a safe and effective surgical option for internal fistulas in diverticular disease, offering acceptable morbidity and mortality.
    • Staged procedures should be reserved for select patients, as primary repair is now the preferred approach.