Internal colonic fistulae: experience with en-bloc extended low anterior resections

ABSTRACT

Thus study was undertaken to assess the results of using extended en bloc low anterior resection in patients with internal colonic fistulae regardless of the aetiology of the fistula. Eighteen patients [10 women, 66%; 8 men, 44%] who ranged in age from 23 to 86 years [median 67.5 years] were seen between 1996 to early 2000. The types of fistulas included 8 colovesical [44%], 5 colovaginal [28%] and 3 coloenteric [17%]. Two patients had complex fistulae involving more than 2 organs [11%]. The cause of the fistula was diverticulitis in 10 patients [56%] cancer in 5 patients [28%], Crohn's disease in 2 patients [11%] and localized bowel ischaemia in 1 patient [6%]. Fifteen patients [83%] had definitive en bloc resections, while 3 patients had diverting transverse loop colostomy only because of advanced malignancy. Stapled low anterior resection en bloc- with a second organ and omental interposition was performed in 11 patients [9 patients had omental interposition and 3 had covering stomas]. En bloc colonic and small bowel resections with hand-sewn anastomoses was done in 3 patients, One patient had a Hartmann's procedure. The hospital stay ranged from 6 to 63 days [median 12 days]. There were no operative deaths and no clinical anastomotic leaks. The postoperative course was uncomplicated in 72%, while 5 patients [28%] experienced complications. En bloc radical resections with primary anastomosis can be accomplished safely in patients with internal colonic fistulae. Extended resections allow safe anastomosis to be carried out in pliable non-inflammed tissues, guards against future recurrence of diverticulitis without any increase in morbidity. They also ensure adequate resections in cancer patients and when the diagnosis is in doubt