44660 Closure of enterovesical fistula; without intestinal or bladder resection

Name of the Procedure:

Closure of Enterovesical Fistula; Without Intestinal or Bladder Resection

Summary

The procedure involves surgically closing a fistula, an abnormal connection, between the intestine and the bladder without removing any portion of the intestine or bladder. This helps to restore normal function by preventing the passage of intestinal contents into the bladder.

Purpose

The procedure addresses the presence of an enterovesical fistula. The goal is to correct this abnormal connection to prevent symptoms such as recurrent urinary tract infections, passage of gas or feces in the urine, and abdominal pain. Successful closure should improve the patient's quality of life and eliminate related infections and discomfort.

Indications

• Recurrent urinary tract infections
• Passage of gas or feces in urine (pneumaturia or fecaluria)
• Abdominal pain associated with urinary symptoms
• Diagnosis of enterovesical fistula via imaging or other diagnostic tests
• Patients who are otherwise fit for surgical intervention

Preparation

• Patients may be instructed to fast for a certain period before the procedure, usually 6-8 hours.
• Preoperative imaging studies such as CT scans or MRI may be required to delineate the anatomy of the fistula.
• Bowel preparation might be needed, including the use of laxatives or enemas.
• Medications such as blood thinners may need to be adjusted or paused.
• Preoperative antibiotics might be administered to reduce the risk of infection.

Procedure Description

1. The patient is placed under general anesthesia.
2. An incision is made in the abdominal wall to access the site of the fistula.
3. The fistula is carefully identified and isolated.
4. The fistulous tract is sutured closed using specialized surgical stitches to ensure there is no longer any connection between the intestine and the bladder.
5. The surgical area is inspected to ensure there is no leakage, and additional sutures may be placed if necessary.
6. The abdominal incision is closed in layers.

Tools and equipment used include surgical sutures, retractors, and imaging devices for intraoperative guidance.

Duration

The procedure typically takes between 2 to 4 hours, depending on the complexity of the fistula.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon
• Surgical assistant(s)
• Anesthesiologist
• Operating room nurse(s)
• Scrub technician

Risks and Complications

• Infection
• Bleeding
• Injury to surrounding organs (e.g., intestines, bladder)
• Recurrence of the fistula
• Anesthetic complications
• Postoperative ileus (temporary paralysis of the intestines)
• Urinary issues (e.g., incontinence, retention)

Benefits

• Resolution of symptoms such as recurrent urinary tract infections and abnormal passage of intestinal contents.
• Improvement in quality of life.
• Reduction in pain and discomfort.
• The benefits are often realized shortly after the healing process is underway, usually within a few weeks.

Recovery

• Hospital stay of 3-7 days post-procedure for monitoring and initial recovery.
• Follow-up appointments for wound check and imaging to ensure successful closure.
• Instructions for wound care and activity restrictions.
• Gradual return to normal activities over 4-6 weeks.
• Pain management with prescribed medications.

Alternatives

• Conservative management with antibiotics for recurrent infections (may not resolve fistula)
• Endoscopic attempts at fistula closure (less invasive, but may not be as effective)
• Fistula resection with intestinal or bladder resection (more invasive, longer recovery but may be necessary in complex cases)

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. After the procedure, there will be some discomfort and pain at the surgical site, which will be managed with pain relief medications. Patients may experience initial difficulty with bowel movements and urination, which typically improves over time. Regular follow-up will help manage recovery and address any complications promptly.