Name of the Procedure:

Closure of Rectovesical Fistula
Common names: Rectovesical Fistula Repair, Rectourethral Fistula Closure

Summary

Closure of a rectovesical fistula involves surgically repairing an abnormal connection between the rectum and the bladder or urethra. This procedure is typically necessary to prevent infections and restore normal function.

Purpose

The medical condition it addresses is a rectovesical fistula, an abnormal connection between the rectum and the bladder/urethra. The goal is to close the fistula, preventing urine from leaking into the rectum and stool from entering the urinary system, thereby reducing infection risk and improving quality of life.

Indications

• Persistent urinary infections due to fecal contamination
• Passage of gas or stool through the urinary tract
• Chronic drainage from the rectum or urinary tract
• Inflammation or irritation in the pelvic area

Preparation

• Fasting for 8-12 hours prior to surgery
• Adjusting or pausing certain medications as directed by the healthcare provider
• Preoperative imaging tests such as MRI, CT scan, or cystography
• Bowel preparation, including enemas or laxatives

Procedure Description

1. The patient is placed under general anesthesia.
2. A surgical incision is made to access the fistula.
3. The fistula is identified, and the surrounding tissue is inspected.
4. The fistula tract is carefully dissected and separated from both the bladder/urethra and the rectum.
5. Each side is closed using sutures, and tissue flaps may be used to reinforce the closure.
6. Drains may be placed to prevent fluid accumulation.
7. The surgical site is closed using sutures or staples.

Tools and equipment: Surgical scalpels, retractors, sutures, tissue flaps, surgical drains
Anesthesia: General anesthesia is typically used.

Duration

The procedure typically takes 2 to 4 hours, depending on the complexity of the fistula and surrounding tissue condition.

Setting

This surgery is usually performed in a hospital operating room.

Personnel

• Surgeon (typically a colorectal surgeon or urologist)
• Surgical nurses
• Anesthesiologist
• Surgical technician

Risks and Complications

• Infection at the surgical site
• Bleeding
• Recurrence of the fistula
• Injury to nearby organs, such as the bladder, urethra, or rectum
• Urinary incontinence
• Bowel incontinence
• Postoperative pain

Benefits

• Restoration of normal urinary and bowel function
• Reduction in the risk of infections
• Improvement in overall quality of life
• Relief from the symptoms caused by the fistula

Recovery

• Hospital stay of several days for monitoring
• Pain management with prescribed medications
• Gradual return to normal diet and activities
• Avoidance of heavy lifting and strenuous activities for 4-6 weeks
• Follow-up appointments to monitor healing and ensure no recurrence
• Possible use of catheters temporarily to protect surgical repairs

Alternatives

• Conservative management (diet, antibiotics) when surgery is high-risk
• Diverting colostomy or urostomy to manage symptoms temporarily
• Endoscopic techniques in select, less severe cases

Patient Experience

Patients may experience some pain and discomfort during recovery, which is managed with pain relief medications. They may initially have a urinary catheter and need to follow specific dietary and activity restrictions for a few weeks. Gradual improvement in symptoms is typically observed within a few weeks to months, with close follow-up to ensure proper healing.