Ileal Neobladder Operation Versus Simple Fistulas Resection in Patients with Enterovesical Fistula after Radiotherapy

Author(s):
Yuan Li, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University; Jianan Ren, Nanjing General Hospital of Nanjing; Gefei Wang, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University; Gusheng Gu, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University; Xiuwen Wu, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University; Song Liu, Drum Tower Hospital, Medical school of Nanjing University; Jieshou Li, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University

Background:

Enterovesical fistula represents an abnormal communication between the intestine and the bladder. Enterovesical fistula is a rare but severe complication of pelvic radiation and it can occur years after radiation therapy even in the absence of tumour recurrence. Physicians chose ileal neobladder operation as a new technology to treat enterovesical fistula instead of simple fistulas resection recently.

Hypothesis:

Ileal neobladder operation can decrease the postoperative complications of enterovesical fistula related surgery.

Methods:

Eighteen patients with a definite diagnosis of enterovesical fistula after radiotherapy were studied retrospectively. Nine patients received ileal neobladder operation, while others received simple fistulas resection. We accessed the relationship between complications and choices of operations.

Results:

Hospitalization days in ileal neobladder operation group (93.1±42.5 days) were longer than simple fistulas resection group (57.2±26.9 days, P=0.048). Hospitalization costs was also higher in ileal neobladder operation group(44935.8±24105.0 dollars versus 24807.7±12527.8 dollars, P=0.041). Postoperative urinary tract infection and hemorrhage emerged less and later in ileal neobladder operation group respectively (0 versus 66.7%, P=0.004; 11.1% versus 100.0%, P=0.001).

Conclusions:

In our study, ileal neobladder operation is a better option for surgeons to treat radiation-enterovesical fistula . It decreases and delays the occurance of urinary tract infection and hemorrhage.