Outcome of Surgery for Colovesical and Colovaginal Fistulas of Diverticular Origin in 40 Patients

• Published in: Journal of gastrointestinal surgery 2012-08, Vol.16 (8), p.1559-1565
• Main Authors: Smeenk, R. M., Plaisier, P. W., van der Hoeven, J. A. B., Hesp, W. L. E. M.
• Format: Article
• Language: English
• Subjects: Abdomen; Abscesses; Age; Aged; Aged, 80 and over; Anastomosis, Surgical; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Body mass index; Colectomy; Colon, Sigmoid - surgery; Colonic Diseases - etiology; Colonic Diseases - mortality; Colonic Diseases - surgery; Comorbidity; Diabetes; Diverticulitis; Diverticulitis, Colonic - complications; Female; Fistula; Gastroenterology; Hospitals; Humans; Hysterectomy; Ileostomy; Intestinal Fistula - etiology; Intestinal Fistula - mortality; Intestinal Fistula - surgery; Male; Medical personnel; Medicine; Medicine & Public Health; Middle Aged; Morbidity; Mortality; Multivariate Analysis; Original Article; Ostomy; Patients; Radiation therapy; Rectum - surgery; Retrospective Studies; Sepsis; Society; Statistical analysis; Steroids; Surgeons; Surgery; Surgical anastomosis; Treatment Outcome; Urinary Bladder Fistula - etiology; Urinary Bladder Fistula - mortality; Urinary Bladder Fistula - surgery; Vaginal Fistula - etiology; Vaginal Fistula - mortality; Vaginal Fistula - surgery
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-012-1919-1

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.