Abstract:Ileovesical fistulas (IVFs) are an uncommon complication of Crohn's disease. The aim of this study is to compare long-term surgical outcomes, assess quality of life, and quantify patient satisfaction after IVF repair. A retrospective chart review followed by a prospective survey was carried out. Survey questions focused on patient satisfaction and quality of life after repair of IVF. Fifty-one patients were identified from an administrative database. Mean follow-up was 4.3 years with a response rate of 51 per … Show more
“…Factors that determine choice of treatment include severity of disease and symptoms, presence of complications such as abscess or bowel obstruction, and surgeon preference. 8 There are few studies from before the anti-TNF era evaluating surgical treatment for EVF. They showed that surgical treatment had good results with a low rate of complications.…”
Section: Discussionmentioning
confidence: 99%
“…7 The most commonly cited etiology of ileovesical fistula (IVF) is CD, with an incidence of 2%. 8 Recurrent urinary tract symptoms, need for antibiotics, repeated hospital admissions, and poor quality of life prompt patients to request definitive therapy in both types of fistulas. With its relatively challenging anatomic location and the dense inflammatory process that often occludes the pelvis, some surgeons consider this disorder still as too technically challenging for laparoscopic surgery.…”
Section: Introductionmentioning
confidence: 99%
“…10–13 Although the numbers are small, these studies show that the laparoscopic approach is safe, the conversion rate ranges from 6% to 36%, and its outcome is similar to laparoscopic surgery of uncomplicated diverticulitis and terminal ileitis. 8,10–12…”
Background and Objective:Entero vesical fistulas (EVFs) are an uncommon complication mainly of diverticular disease (70%) and less commonly of Crohn's disease (10%). Only about 10% are caused by malignancies. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with EVF. The aim of this study was to assess the feasibility and safety of laparoscopic surgery in the treatment of EVFs in patients with complicated diverticular and Crohn's disease.Methods:All patients with the diagnosis of EVF who underwent laparoscopic surgery were identified from prospective collected data based in two institutions between 2007 and 2017. Patients with malignancy were excluded. Recorded parameters included operative time, conversion to open surgery, the presence of a protective loop ileostomy, perioperative complications, number of units of blood transfused, postoperative course, and histologic findings.Results:Seventeen patients were included in the study: 10 patients with a colo-vesical fistula due to diverticular disease, and 7 patients with an ileo-vesical fistula due to Crohn's disease. There were no conversions to open surgery and none of the patients needed a protective ileostomy. The bladder was sutured in 12 patients (70%). No intra-operative complications were met, and no blood transfusions were needed; there were no anastomotic leaks, nor mortality in both groups.Conclusions:The laparoscopic approach for benign EVF in selected patients is both feasible and safe in the hands of experienced surgeons with extensive expertise in laparoscopic surgery.
“…Factors that determine choice of treatment include severity of disease and symptoms, presence of complications such as abscess or bowel obstruction, and surgeon preference. 8 There are few studies from before the anti-TNF era evaluating surgical treatment for EVF. They showed that surgical treatment had good results with a low rate of complications.…”
Section: Discussionmentioning
confidence: 99%
“…7 The most commonly cited etiology of ileovesical fistula (IVF) is CD, with an incidence of 2%. 8 Recurrent urinary tract symptoms, need for antibiotics, repeated hospital admissions, and poor quality of life prompt patients to request definitive therapy in both types of fistulas. With its relatively challenging anatomic location and the dense inflammatory process that often occludes the pelvis, some surgeons consider this disorder still as too technically challenging for laparoscopic surgery.…”
Section: Introductionmentioning
confidence: 99%
“…10–13 Although the numbers are small, these studies show that the laparoscopic approach is safe, the conversion rate ranges from 6% to 36%, and its outcome is similar to laparoscopic surgery of uncomplicated diverticulitis and terminal ileitis. 8,10–12…”
Background and Objective:Entero vesical fistulas (EVFs) are an uncommon complication mainly of diverticular disease (70%) and less commonly of Crohn's disease (10%). Only about 10% are caused by malignancies. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with EVF. The aim of this study was to assess the feasibility and safety of laparoscopic surgery in the treatment of EVFs in patients with complicated diverticular and Crohn's disease.Methods:All patients with the diagnosis of EVF who underwent laparoscopic surgery were identified from prospective collected data based in two institutions between 2007 and 2017. Patients with malignancy were excluded. Recorded parameters included operative time, conversion to open surgery, the presence of a protective loop ileostomy, perioperative complications, number of units of blood transfused, postoperative course, and histologic findings.Results:Seventeen patients were included in the study: 10 patients with a colo-vesical fistula due to diverticular disease, and 7 patients with an ileo-vesical fistula due to Crohn's disease. There were no conversions to open surgery and none of the patients needed a protective ileostomy. The bladder was sutured in 12 patients (70%). No intra-operative complications were met, and no blood transfusions were needed; there were no anastomotic leaks, nor mortality in both groups.Conclusions:The laparoscopic approach for benign EVF in selected patients is both feasible and safe in the hands of experienced surgeons with extensive expertise in laparoscopic surgery.
“… 164 Meanwhile, it has been reported that most of the patients with ileovesical fistulas who underwent surgery showed improved quality of life during long-term follow-up. 165 Therefore, surgery is usually preferred for enterovesical fistulas; however, medical treatment can be considered in patients who already underwent multiple operations or are at high risk of short bowel syndrome.…”
Section: Treatment Of CD With Stricture or Fistulamentioning
Crohn's disease (CD) is a chronic, progressive, and disabling inflammatory bowel disease (IBD) with an uncertain etiopathogenesis. CD can involve any site of the gastrointestinal tract from the mouth to the anus, and is associated with serious complications, such as bowel strictures, perforations, and fistula formation. The incidence and prevalence rates of CD in Korea are still lower compared with those in Western countries, but they have been rapidly increasing during the recent decades. Although there are no definitive curative modalities for CD, various medical and surgical therapies have been applied for the treatment of this disease. Concerning CD management, there have been substantial discrepancies among clinicians according to their personal experience and preference. To suggest recommendable approaches to the diverse problems of CD and to minimize the variations in treatment among physicians, guidelines for the management of CD were first published in 2012 by the IBD Study Group of the Korean Association for the Study of Intestinal Diseases. These are the revised guidelines based on updated evidence, accumulated since 2012. These guidelines were developed by using mainly adaptation methods, and encompass induction and maintenance treatment of CD, treatment based on disease location, treatment of CD complications, including stricture and fistula, surgical treatment, and prevention of postoperative recurrence. These are the second Korean guidelines for the management of CD and will be continuously revised as new evidence is collected.
“…Entero‐enteric fistulas are usually asymptomatic and require surgery only if they cause malabsorption or diarrhoea . For entero‐urogenital fistula, surgery is still superior to medical therapy, but again medial therapy may be attempted (see Sections and ).…”
Section: Small Bowel Surgery In Crohn's Diseasementioning
Aim
There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology.
Methods
Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines.
Results
All aspects of surgical care for IBD have been included along with 157 recommendations for management.
Conclusion
These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.
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