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01-09-2019 | Original Article

Perioperative Management of Patients with Colovesical Fistula

Authors: Scott C. Dolejs, Alyssa J. Penning, Michael J. Guzman, Alyssa D. Fajardo, Bryan K. Holcomb, Bruce W. Robb, Joshua A. Waters

Published in: Journal of Gastrointestinal Surgery | Issue 9/2019

Abstract

Background

Colovesical fistula (CVF) is an uncommon complication of diverticulitis. Substantial heterogeneity exists in the perioperative management of this condition. We seek to evaluate the role of bladder leak testing, closed suction drainage, prolonged bladder catheter usage, and routine postoperative cystogram in the management of CVF.

Study Design

This is a retrospective study from a single academic health center investigation patients undergoing operation for diverticular CVF from 2005 to 2015 (n = 89).

Results

Patients undergoing operative repair for diverticular CVF resection had a mortality of 4% and overall morbidity of 46%. Intraoperative bladder leak test was performed in 36 patients (40%) and demonstrated a leak in 4 patients (11%). No patients with a negative intraoperative bladder leak test developed a urinary leak. Overall, five (6%) patients developed postoperative bladder leak. Three were identified by elevated drain creatinine and two by cystogram. The diagnostic yield of routine cystogram was 3%. All bladder leaks were diagnosed between postoperative day 3 and 7. Of patients with a postoperative bladder leak, none required reoperation and all resolved within 2 months.

Conclusions

There is significant variability in the management of patients undergoing operation for CVF. Routine intraoperative bladder leak test should be performed. Cystogram may add cost and is low yield for routine evaluation for bladder leak after operation for CVF. Urinary catheter removal before postoperative day 7 should be considered.

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Title: Perioperative Management of Patients with Colovesical Fistula
Authors: Scott C. Dolejs
Alyssa J. Penning
Michael J. Guzman
Alyssa D. Fajardo
Bryan K. Holcomb
Bruce W. Robb
Joshua A. Waters
Publication date: 01-09-2019
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 9/2019
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-018-4034-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative Management of Patients with Colovesical Fistula

Abstract

Background

Study Design

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Study Design

Results

Conclusions

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