Conor Holland1, Benjamin W Vabi2, Preeti P Shenoy3, Joseph Riad4, Theresa Colbert5, Lynn Shaffer6, Jaswant Madhavan5. 1. Graduate Medical Education, General Surgery Program, Mount Carmel Health System, 5300 North Meadows Drive, Grove City, Columbus, OH, 43123, USA. Conor.Holland001@mchs.com. 2. Wellspan Medical Group, York, PA, USA. 3. Oroville Hospital, Oroville, CA, USA. 4. Memorial Sloan Kettering Cancer Center, New York, NY, USA. 5. Dept. of Colon & Rectal Surgery, Mount Carmel Health System, Columbus, OH, USA. 6. Mount Carmel Research Institute, Columbus, OH, USA.
Abstract
BACKGROUND: Colovesical fistulas are uncommon but associated with significant morbidity and reduced quality of life. In cases with diverticular etiology, surgical management involves single-stage colonic resection with anastomosis and simple or no bladder repair. No single approach to postoperative bladder management has been widely accepted. Although historically a Foley catheter remained in place for about 2 weeks, elevated risk of the attendant complications has motivated exploring shorter durations. This study examined the feasibility and safety of removing the Foley catheter on postoperative day two. METHODS: Patients with colovesical fistula due to diverticular disease undergoing colectomy with simple or no bladder repair were enrolled in this single-arm prospective trial conducted at a large community health system. The primary outcome was removal of the Foley catheter on postoperative day two after negative cystogram without re-insertion prior to hospital discharge. Secondary outcomes were complications after Foley catheter removal and hospital length of stay. Ninety-five percent confidence intervals were calculated for the outcomes. RESULTS: Twenty-four patients were enrolled. About half (54%) of procedures were open, with 33% requiring simple bladder repair. Ninety-six percent (95% confidence interval, 79-99%) of patients had their Foley catheter removed on postoperative day two after a negative cystogram. There were no complications. Mean (range) hospital length of stay was 4.3 (2-6) days. DISCUSSION: Foley catheter removal after negative cystogram on postoperative day two appears to be feasible and safe in the setting of diverticulitis-related colovesical fistula repair. Further research on a larger number of patients should confirm these findings.
BACKGROUND: Colovesical fistulas are uncommon but associated with significant morbidity and reduced quality of life. In cases with diverticular etiology, surgical management involves single-stage colonic resection with anastomosis and simple or no bladder repair. No single approach to postoperative bladder management has been widely accepted. Although historically a Foley catheter remained in place for about 2 weeks, elevated risk of the attendant complications has motivated exploring shorter durations. This study examined the feasibility and safety of removing the Foley catheter on postoperative day two. METHODS: Patients with colovesical fistula due to diverticular disease undergoing colectomy with simple or no bladder repair were enrolled in this single-arm prospective trial conducted at a large community health system. The primary outcome was removal of the Foley catheter on postoperative day two after negative cystogram without re-insertion prior to hospital discharge. Secondary outcomes were complications after Foley catheter removal and hospital length of stay. Ninety-five percent confidence intervals were calculated for the outcomes. RESULTS: Twenty-four patients were enrolled. About half (54%) of procedures were open, with 33% requiring simple bladder repair. Ninety-six percent (95% confidence interval, 79-99%) of patients had their Foley catheter removed on postoperative day two after a negative cystogram. There were no complications. Mean (range) hospital length of stay was 4.3 (2-6) days. DISCUSSION: Foley catheter removal after negative cystogram on postoperative day two appears to be feasible and safe in the setting of diverticulitis-related colovesical fistula repair. Further research on a larger number of patients should confirm these findings.
Authors: Marc A de Moya; Nikolaos Zacharias; Audley Osbourne; Muhammad Umar Butt; Hasan B Alam; David R King; Francis McGovern; George C Velmahos Journal: J Surg Res Date: 2009-05-08 Impact factor: 2.192