Perioperative Management of Patients with Colovesical Fistula.

Autor: Dolejs SC; Department of Surgery, Indiana University School of Medicine, Indianapolis, USA., Penning AJ; Department of Surgery, Indiana University School of Medicine, Indianapolis, USA., Guzman MJ; Department of Surgery, Indiana University School of Medicine, Indianapolis, USA., Fajardo AD; Department of Surgery, Indiana University School of Medicine, Indianapolis, USA., Holcomb BK; Department of Surgery, Indiana University School of Medicine, Indianapolis, USA., Robb BW; Department of Surgery, Indiana University School of Medicine, Indianapolis, USA., Waters JA; Department of Surgery, Indiana University School of Medicine, Indianapolis, USA. jwaters1@iuhealth.org.; 1801 N. Senate Blvd., Suite 635, Indianapolis, IN, 46202, USA. jwaters1@iuhealth.org.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2019 Sep; Vol. 23 (9), pp. 1867-1873. Date of Electronic Publication: 2018 Nov 08.
DOI: 10.1007/s11605-018-4034-0
Abstrakt: 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.
Databáze: MEDLINE
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