Abstract
Early Removal of Foley Catheter after Sigmoid Colectomy for Diverticular Colovesical Fistula without Intraoperative Bladder Repair or Postoperative Cystography: Feasibility of a Quality Improvement Pilot Program
Highlights
The treatment of colovesical fistula (CVF) due to diverticular disease is complex and imposes significant risk to the patient
Bladder defects were only formally repaired if urothelium was visualized intraoperatively
There were no urinary-related complications or mortalities, and mean follow-up was 249 ± 60 days. This quality improvement pilot study supports early catheter removal (< 7 days) and suggests bladder imaging may be unnecessary in select cases
Summary
Diverticulitis is the most common cause of colovesical fistula, yet it is an uncommon complication and occurs in approximately 1-4% of cases [1,2]. The standard approach for definitive management of CVF includes partial colectomy of the involved segment (usually sigmoid colon), takedown of the fistulous tract, and closure of the bladder defect [1,3]. The laparoscopic approach is associated with a shorter length of hospital stay and lower overall complication rates, and has gained favor as the preferred surgical approach to treat colovesical fistula [3,4,5,6,7,8]. The surgical approach to CVF is technically challenging and is often associated with dense inflammatory adhesions between the colon and bladder. There is no standard management of the bladder defect after fistula takedown. The integrity of the bladder can be assessed intraoperative with provocative leak testing (for example, by instilling dyed saline into the bladder), and postoperatively with
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