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Outcome of surgery for colovesical and colovaginal fistulas of diverticular origin in 40 patients.
J Gastrointest Surg. 2012 Aug; 16(8):1559-65.JG

Abstract

INTRODUCTION

According to literature, colonic resection with a primary anastomosis and no defunctioning ileostomy is a safe treatment for colovesical or colovaginal fistula of diverticular origin. This study investigates the outcome of surgery for this patient group in a regional hospital.

METHODS

Patients were obtained from a prospective database in the period 2004-2011. Several variables were investigated for their relation with surgical outcome.

RESULTS

A colovesical (n = 35) or colovaginal (n = 5) fistula was diagnosed in 18 men and 22 women. The mean age was 69 years (range, 45-90). A rectosigmoid resection with primary anastomosis was performed in 32 patients. Fourteen patients received a defunctioning ileostomy. Eight patients were treated with a Hartmann procedure. Overall 30-day treatment-related morbidity and mortality was 48 and 8 %, respectively. Major morbidity, because of anastomotic leakage, was mainly observed in the primary anastomosis group without a defunctioning ileostomy. Morbidity and mortality were associated with high body mass index, diabetes, use of corticosteroids, and American Society of Anesthesiologists classification, though not significantly.

CONCLUSIONS

One should be liberal in the use of a defunctioning ileostomy in case of a primary anastomosis after colonic resection for a diverticular fistula, in order to prevent high morbidity rates due to anastomotic leakage.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Smeenk RM
Department of Surgery, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands.
Plaisier PW
No affiliation info available
van der Hoeven JA
No affiliation info available
Hesp WL
No affiliation info available

MeSH

AgedAged, 80 and overAnastomosis, SurgicalAnastomotic LeakColectomyColon, SigmoidColonic DiseasesDiverticulitis, ColonicFemaleHumansIleostomyIntestinal FistulaMaleMiddle AgedMultivariate AnalysisRectumRetrospective StudiesTreatment OutcomeUrinary Bladder FistulaVaginal Fistula

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

22653331

Citation

Smeenk, R M., et al. "Outcome of Surgery for Colovesical and Colovaginal Fistulas of Diverticular Origin in 40 Patients." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 16, no. 8, 2012, pp. 1559-65.
Smeenk RM, Plaisier PW, van der Hoeven JA, et al. Outcome of surgery for colovesical and colovaginal fistulas of diverticular origin in 40 patients. J Gastrointest Surg. 2012;16(8):1559-65.
Smeenk, R. M., Plaisier, P. W., van der Hoeven, J. A., & Hesp, W. L. (2012). Outcome of surgery for colovesical and colovaginal fistulas of diverticular origin in 40 patients. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 16(8), 1559-65. https://doi.org/10.1007/s11605-012-1919-1
Smeenk RM, et al. Outcome of Surgery for Colovesical and Colovaginal Fistulas of Diverticular Origin in 40 Patients. J Gastrointest Surg. 2012;16(8):1559-65. PubMed PMID: 22653331.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcome of surgery for colovesical and colovaginal fistulas of diverticular origin in 40 patients. AU - Smeenk,R M, AU - Plaisier,P W, AU - van der Hoeven,J A B, AU - Hesp,W L E M, Y1 - 2012/06/01/ PY - 2012/03/06/received PY - 2012/05/15/accepted PY - 2012/6/2/entrez PY - 2012/6/2/pubmed PY - 2012/12/12/medline SP - 1559 EP - 65 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J Gastrointest Surg VL - 16 IS - 8 N2 - INTRODUCTION: According to literature, colonic resection with a primary anastomosis and no defunctioning ileostomy is a safe treatment for colovesical or colovaginal fistula of diverticular origin. This study investigates the outcome of surgery for this patient group in a regional hospital. METHODS: Patients were obtained from a prospective database in the period 2004-2011. Several variables were investigated for their relation with surgical outcome. RESULTS: A colovesical (n = 35) or colovaginal (n = 5) fistula was diagnosed in 18 men and 22 women. The mean age was 69 years (range, 45-90). A rectosigmoid resection with primary anastomosis was performed in 32 patients. Fourteen patients received a defunctioning ileostomy. Eight patients were treated with a Hartmann procedure. Overall 30-day treatment-related morbidity and mortality was 48 and 8 %, respectively. Major morbidity, because of anastomotic leakage, was mainly observed in the primary anastomosis group without a defunctioning ileostomy. Morbidity and mortality were associated with high body mass index, diabetes, use of corticosteroids, and American Society of Anesthesiologists classification, though not significantly. CONCLUSIONS: One should be liberal in the use of a defunctioning ileostomy in case of a primary anastomosis after colonic resection for a diverticular fistula, in order to prevent high morbidity rates due to anastomotic leakage. SN - 1873-4626 UR - https://www.unboundmedicine.com/medline/citation/22653331/Outcome_of_surgery_for_colovesical_and_colovaginal_fistulas_of_diverticular_origin_in_40_patients_ L2 - https://dx.doi.org/10.1007/s11605-012-1919-1 DB - PRIME DP - Unbound Medicine ER -