Name of the Procedure:

Closure of rectovesical fistula; with colostomy

Summary

A closure of rectovesical fistula with colostomy is a surgical procedure to repair an abnormal connection between the rectum and bladder (rectovesical fistula) and to divert fecal matter through a temporary opening in the abdominal wall (colostomy). This can prevent infection and allow the damaged areas to heal properly.

Purpose

This procedure is used to treat rectovesical fistulas, which can cause frequent infections and other complications. The goal is to close the abnormal passage, prevent further infections, and facilitate the healing of both the bladder and the rectum.

Indications

• Chronic urinary tract infections
• Fecal matter or gas passing through the urethra
• Pain and discomfort in the pelvic region
• History of pelvic surgery, diverticulitis, or inflammatory bowel disease

Preparation

• Fasting for at least 8 hours before the procedure
• Discontinuation of certain medications, as advised by the doctor
• Preoperative imaging tests such as CT scans or MRI
• Colon cleansing regimen, if instructed by the healthcare provider

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: An incision is made in the abdomen to access the rectum and bladder.
3. Fistula Closure: The surgeon identifies the fistula and closes it using sutures.
4. Colostomy Creation: A separate incision is made to create a colostomy, a temporary opening in the abdominal wall where a part of the colon is brought out to allow stool to exit the body via a colostomy bag.

5. Final Steps: The incisions are closed with stitches and covered with dressings.

   Tools include surgical sutures, scalpels, and colostomy supplies.

Duration

Approximately 3 to 5 hours, depending on the complexity of the fistula and any additional findings during surgery.

Setting

Typically performed in a hospital operating room.

Personnel

• Surgeons specialized in colorectal surgery
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding
• Short-term or long-term bowel obstruction
• Complications related to anesthesia
• Risk of fistula recurrence

Benefits

• Resolution of symptoms related to the fistula
• Prevention of further infections
• Improved quality of life

Recovery

• Patients may need to stay in the hospital for 5 to 7 days.
• Instructions include wound care, managing the colostomy, and diet modifications.
• Full recovery may take several weeks to months.
• Follow-up appointments for monitoring healing and potentially reversing the colostomy.

Alternatives

• Endoscopic procedures for smaller fistulas
• Non-surgical management with antibiotics and catheter drainage (less effective for large or persistent fistulas)
• Pros of alternatives: Less invasive, shorter recovery time
• Cons: Higher risk of fistula recurrence, potential for chronic issues

Patient Experience

During the procedure, patients will be asleep under general anesthesia. Post-procedure, patients may experience discomfort and will receive pain management. The colostomy requires learning how to care for the stoma and manage the colostomy bag, which can be initially challenging but becomes manageable over time with practice and support.