Closure of Enterovesical Fistula with Intestine and/or Bladder Resection

Name of the Procedure:

• Common Name(s): Fistula repair surgery
• Technical Terms: Enterovesical fistula closure; intestinal resection; bladder resection

Summary

The closure of an enterovesical fistula is a surgical procedure to repair an abnormal connection between the intestine and bladder, often requiring removal of part of the intestine or bladder.

Purpose

• Medical Condition: To correct an enterovesical fistula, which is an unnatural connection between the bladder and intestines.
• Goals: To eliminate infection, prevent urine and fecal matter from mixing, and restore normal function of the bladder and intestines.

Indications

• Symptoms: Recurrent urinary tract infections, pneumaturia (air in urine), fecaluria (feces in urine), abdominal pain.
• Criteria: Confirmed diagnosis of an enterovesical fistula through imaging tests (CT scan, MRI), failure of conservative treatments.

Preparation

• Instructions: Fasting for at least 8 hours before surgery, bowel preparation, cessation of certain medications.
• Diagnostic Tests: Blood tests, imaging scans, possibly a colonoscopy or cystoscopy to visualize the fistula.

Procedure Description

1. Anesthesia: General anesthesia will be given to the patient to ensure they are asleep and pain-free.
2. Incision: An abdominal incision is made to access the bladder and intestines.
3. Resection: The surgeon will locate the fistula and may remove part of the intestine (intestinal resection) and part of the bladder (bladder resection) if necessary.
4. Closure: The remaining healthy parts of the intestine and bladder are then stitched closed.
5. Inspection: The area is carefully checked for leaks or issues before closing the surgical incision.

• Tools/Equipment: Surgical instruments, sutures, possibly laparoscopic equipment if performed minimally invasively.

Duration

The procedure typically takes between 3 to 6 hours, depending on the complexity.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Surgeons: One or more surgeons specialized in gastrointestinal or urological surgery.
• Support Staff: Nurses, surgical assistants, anesthesiologist.

Risks and Complications

• Common Risks: Infection, bleeding, reaction to anesthesia.
• Rare Risks: Recurrence of the fistula, injury to nearby organs, long-term bowel or bladder dysfunction.
• Management: Immediate post-operative monitoring, antibiotics for infections, and additional surgeries if complications occur.

Benefits

• Expected Benefits: Resolution of fistula symptoms, improved quality of life, reduced risk of recurrent infections.
• Timeline: Benefits often realized within a few weeks to a few months post-surgery.

Recovery

• Post-Procedure Care: Hospital stay of several days, pain management, gradual progression from liquid to solid diet.
• Instructions: Avoid strenuous activities for several weeks, follow-up appointments for monitoring and removal of stitches or staples.
• Recovery Time: Typically, 6 to 8 weeks for complete recovery.

Alternatives

• Other Treatments: Non-surgical options include antibiotics and catheterization, though these are usually temporary measures.
• Comparison: Surgery is generally more definitive and effective, whereas non-surgical treatments risk recurrence and do not repair the fistula.

Patient Experience

• During Procedure: The patient will be under general anesthesia and should feel no pain.
• Post-Procedure: Pain management will be provided, and patients may experience discomfort, fatigue, and pain at the incision site. Comfort measures include pain medication and supportive care from hospital staff.