Entero-Vesical Fistula: Concept and Repair

Vincent TseAustralia Moderator

Po-Yen ChenTaiwan Speaker Entero-Vesical Fistula: Concept and RepairEntero-vesical fistulas (EVFs), most commonly colovesical in origin, represent a complex and morbid communication between the gastrointestinal tract and the urinary bladder. They are most frequently caused by diverticulitis, Crohn’s disease, malignancy, or prior radiation. Patients typically present with pneumaturia, fecaluria, and recurrent urinary tract infections. While conservative treatment may be appropriate for select high-risk patients, surgical intervention remains the definitive treatment for most cases. Robotic-assisted repair of EVFs has emerged as a minimally invasive alternative to open surgery, offering advantages in visualization, precision, and tissue handling, especially in cases with extensive adhesions or post-radiation fibrosis. The robotic approach facilitates meticulous dissection, safe resection of the fistula tract, multilayer closure, and reliable interposition of omentum or peritoneal flap. This presentation will review the pathophysiology, diagnostic work-up, and classification of EVFs, and then focus on surgical decision-making and robotic techniques. Step-by-step surgical strategies, technical pearls, and pitfalls will be illustrated using real operative footage. Outcomes from recent literature and expert centers will be discussed, with emphasis on patient selection and factors influencing success. Robotic repair, when performed in experienced hands, provides excellent functional outcomes with low morbidity.