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Laparoscopic bladder-preserving surgery for enterovesical fistula complicated with benign gastrointestinal disease.

Mizushima T, Ikeda M, Sekimoto M, Yamamoto H, Doki Y, Mori M - Case Rep Gastroenterol (2012)

Bottom Line: LBPS for EVF was performed in 4 patients and included 3 direct sharp dissections and 1 stapling dissection.Three of the 4 patients did not require any further treatment for the bladder, and all procedures were feasibly accomplished under laparoscopic conditions.In conclusion, LBPS is feasible in cases of EVF caused by benign gastrointestinal disease, and we suggest that it should be the first choice of intervention in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Osaka University Graduate School of Medicine, Suita, Japan.

ABSTRACT
Enterovesical fistula (EVF) is a relatively uncommon condition that is associated with severe morbidity. Minimally invasive and organ-preserving surgery should be performed in the case of EVF caused by benign diseases. We applied laparoscopic bladder-preserving surgery (LBPS) for EVF caused by benign gastrointestinal disease. Here, we report a surgical technique for LBPS. Patient and instrument port positioning are similar to those used in laparoscopic colorectal surgery. Dissection around the fistula is performed along the intestine as distant from the bladder as possible. If there is sufficient area around the intestinal portion of the fistula, it is isolated and resected using a linear stapler. If this approach is not possible, the intestinal fistula is sharply dissected as far away from the bladder as possible. LBPS for EVF was performed in 4 patients and included 3 direct sharp dissections and 1 stapling dissection. Three of the 4 patients did not require any further treatment for the bladder, and all procedures were feasibly accomplished under laparoscopic conditions. In conclusion, LBPS is feasible in cases of EVF caused by benign gastrointestinal disease, and we suggest that it should be the first choice of intervention in such cases.

No MeSH data available.


Related in: MedlinePlus

Case 2. The patient was a 40-year-old man with EVF caused by diverticulitis of the sigmoid colon. Bladder fistula was identified at the trigone. The inflammatory adhesion around the fistula was very mild, and we could perform taping around the fistula. Thus, we identified the ureter and performed a stapling dissection of the EVF.
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Figure 2: Case 2. The patient was a 40-year-old man with EVF caused by diverticulitis of the sigmoid colon. Bladder fistula was identified at the trigone. The inflammatory adhesion around the fistula was very mild, and we could perform taping around the fistula. Thus, we identified the ureter and performed a stapling dissection of the EVF.

Mentions: The fistula along the diseased intestine is dissected as distant from the bladder as possible. If isolation is not possible, the fistula is sharply dissected along the diseased intestine (fig. 1). If there is sufficient area around the intestinal fistula, it is isolated and resected using a linear stapler (fig. 2).


Laparoscopic bladder-preserving surgery for enterovesical fistula complicated with benign gastrointestinal disease.

Mizushima T, Ikeda M, Sekimoto M, Yamamoto H, Doki Y, Mori M - Case Rep Gastroenterol (2012)

Case 2. The patient was a 40-year-old man with EVF caused by diverticulitis of the sigmoid colon. Bladder fistula was identified at the trigone. The inflammatory adhesion around the fistula was very mild, and we could perform taping around the fistula. Thus, we identified the ureter and performed a stapling dissection of the EVF.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3376346&req=5

Figure 2: Case 2. The patient was a 40-year-old man with EVF caused by diverticulitis of the sigmoid colon. Bladder fistula was identified at the trigone. The inflammatory adhesion around the fistula was very mild, and we could perform taping around the fistula. Thus, we identified the ureter and performed a stapling dissection of the EVF.
Mentions: The fistula along the diseased intestine is dissected as distant from the bladder as possible. If isolation is not possible, the fistula is sharply dissected along the diseased intestine (fig. 1). If there is sufficient area around the intestinal fistula, it is isolated and resected using a linear stapler (fig. 2).

Bottom Line: LBPS for EVF was performed in 4 patients and included 3 direct sharp dissections and 1 stapling dissection.Three of the 4 patients did not require any further treatment for the bladder, and all procedures were feasibly accomplished under laparoscopic conditions.In conclusion, LBPS is feasible in cases of EVF caused by benign gastrointestinal disease, and we suggest that it should be the first choice of intervention in such cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Osaka University Graduate School of Medicine, Suita, Japan.

ABSTRACT
Enterovesical fistula (EVF) is a relatively uncommon condition that is associated with severe morbidity. Minimally invasive and organ-preserving surgery should be performed in the case of EVF caused by benign diseases. We applied laparoscopic bladder-preserving surgery (LBPS) for EVF caused by benign gastrointestinal disease. Here, we report a surgical technique for LBPS. Patient and instrument port positioning are similar to those used in laparoscopic colorectal surgery. Dissection around the fistula is performed along the intestine as distant from the bladder as possible. If there is sufficient area around the intestinal portion of the fistula, it is isolated and resected using a linear stapler. If this approach is not possible, the intestinal fistula is sharply dissected as far away from the bladder as possible. LBPS for EVF was performed in 4 patients and included 3 direct sharp dissections and 1 stapling dissection. Three of the 4 patients did not require any further treatment for the bladder, and all procedures were feasibly accomplished under laparoscopic conditions. In conclusion, LBPS is feasible in cases of EVF caused by benign gastrointestinal disease, and we suggest that it should be the first choice of intervention in such cases.

No MeSH data available.


Related in: MedlinePlus