How are bladder enterovesical fistula repaired?

Updated: Dec 24, 2020
  • Author: Joseph Basler, MD, PhD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Surgical management of the bladder varies. The technique of bladder repair (ie, excision versus oversewing) is not critical, and small defects do not require any particular repair. As long as adequate bladder drainage is provided, variations in bladder management are unlikely to affect the patient outcome. When available, omentum should be applied to the serosal surface . This may be particularly beneficial in the setting of acute traumatic injury to both the bladder and rectum, to aid in healing and may prevent future fistula formation. [27] To date, no studies have demonstrated that the choice of absorbable suture, the number of layers of closure, or the type of postoperative bladder drainage significantly affects outcomes.

Dziki et al conducted a retrospective study of 59 patients with enterovesical fistula from benign causes who underwent an open surgical single- stage procedure with bowel anastomosis, without protective stoma. In 18 patients (31%) with urinary bladder leakage observed, the bladder wall defect was closed with a single No. 0 absorbable polyglactin 910 (Vicryl) suture. No bladder leakage occurred postoperatively in any of the 59 patients, suggesting that closure of the bladder defect is not necessary in cases where a leak is not demonstrated from the bladder intraoperatively. [70]


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