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EARLY REMOVAL OF FOLEY CATHETER AFTER SURGERY FOR COLOVESICAL FISTULA SECONDARY TO DIVERTICULITIS: FRIEND OR FOE?
H. Hande Aydinli*2,1, Gokhan Ozuner2
1Department of Surgery, Division of Colon and Rectal Surgery, New York University , New York, NY; 2Colorectal Surgery, Cleveland Clinic, Cleveland, OH
Introduction: Diverticulitis is the most common disease causing colovesical fistula. Resection and primary anastomosis with or without bladder intervention is the preferred surgical approach. The optimal postoperative management in terms of foley catheter (FC) withdrawal is debated in the literature. The aim of this study was to share our institutional experience while evaluating the difference in the outcomes between early versus late FC removal.
Methods: All patients who underwent colorectal surgery for diverticulitis complicated with colovesical fistula between 01/1994-11/2015 were identified from an IRB-approved, prospectively maintained institutional database. Patients were divided into two groups according to their FC removal day after index surgery (≥7 days, <7days). Morbidity was defined as occurrence of at least one of the following within 30 days of surgery; pneumonia, ileus, small bowel obstruction, urinary tract infection, surgical site infection, wound dehiscence, sepsis, anastomotic leak, arrhythmia and venous thromboembolism.
Results: A total of 162 patients were identified with a mean age of 63 (34-88). 58 patients (36%) were female. Patient demographics, preoperative comorbidities, and operative details are summarized in the table. Mean FC withdrawal day was 8.8 days (1-65). 80 patients (49%) had early FC removal. 50 patients (30%) had ureteric stent placement preoperatively. All patients underwent sigmoid colectomy but only 54 patients (33%) had concurrent bladder repair. 118 patients (73%) had postoperative cystograms to evaluate leak before their FC was removed (62 [78%] patients in the early group and 56 [68%] patients in the late group). 4 patients (5%) experienced urinary tract infection in the early removal group whereas 9 patients (11%) had urinary complications in the late group (p=0.16). Morbidity was higher among patients who had late FC withdrawal (p=0.008). Length of stay was significantly longer in patients with late FC removal (10.3 ±8.2 vs. 5.8 ±2.1 days, p<0.0001).
Conclusion: Late FC removal in patients operated for colovesical fistula secondary to diverticulitis increased postoperative 30-day complications when compared to early FC removal. It may be preferable to perform a cystogram early and if no leak is demonstrated to remove the indwelling catheter to decrease perioperative morbidity and potential length of hospital stay.
Comparison of demographics, preoperative comorbidities and surgical details between the groups.
| | Early removal (<7),
N=80 | Late removal (≥7),
N=82 | p-value | | Age, years* | 62 (52-67) | 67 (58-74) | <0.001 | | Gender (Female) | 24 (30) | 34 (41) | 0.9 | | BMI, kg/m2* | 28 (25-32) | 28 (26-33) | 0.97 | | Diabetes Mellitus | 8 (10) | 12 (15) | 0.37 | | Hypertension | 46 (57) | 47 (57) | 0.98 | | Cardiac Comorbidities | 38 (48) | 39 (48) | 0.99 | | Pulmonary Comorbidities | 15 (19) | 10 (12) | 0.2 | | Renal Comorbidities | 4 (5) | 7 (9) | 0.5 | | ASA Class | | | 0.92 | ASA I-II
ASA-III-IV | 31 (38)
49 (62) | 31 (38)
51 (62) | | | Approach (Laparoscopy) | 41 (51) | 41 (51) | | | Bladder intervention | | | 0.036 | Simple repair
Resection
None | 16 (20)
3 (4)
61 (76) | 28 (34)
7 (9)
47 (57) | | | Preoperative stent placement | 22 (28) | 28 (34) | 0.36 | | Omental flap creation | 32 (40) | 40 (49) | 0.26 | | Stoma creation | 18 (23) | 31 (38) | 0.034 |
Values reported as mean (percentage) otherwise noted. * Values reported as mean (min-max).
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