Introduction This aim of this study is to review how investigation and management of colovesical fistulae has progressed in our institution over a 12-year period and to propose a clear protocol to ensure prompt diagnosis and treatment in the future.
Methods A retrospective case note review was conducted of all patients with colovesical fistulae who underwent definitive surgery over a 12-year period. Variables collected include patient demographics, symptoms, investigations, operative data, histology, complications and length of stay.
Results 56 patients (38 male) underwent operative intervention for colovesical fistula. The most common symptoms are pneumaturia (69%), faecaluria (32%) and symptoms associated with recurrent UTIs (68%). Cystoscopy was the most accurate test to identify fistulae (91%) followed by CT (60%) and barium enema (31%). Two patients were unfit for major surgery and underwent palliative loop colostomies. The most common pathology was diverticular disease. Of the 54 remaining patients, 45% underwent laparoscopic resection with a conversion rate of 33% (due to adhesions or multiple abscesses). Sigmoid colectomy, (52%) anterior resection (30%) and hartmanns (9%) are the most common procedures performed. Bladder repair was required in 25% of cases with a further 16% requiring partial resection. All patients received a postoperative cystogram to ensure bladder had healed and 70% of patients were defunctioned to protect the anastomosis. There was no mortality reported peri-operatively; the anastomotic leak rate was 5% and recurrence rate was 5%. Median postoperative stay was 12.5 days (range 4–91) in the laparoscopic group and 16 days (range 6–62) in the open group.
Conclusion Surgical management for colovesical fistulae is effective and safe. Laparoscopic resections are increasing in popularity and deliver encouraging results comparable to open resection. A large multi-centre randomised controlled trial is required to validate its potential benefits over open surgery.
Competing interests None declared.
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