Surgical treatment strategies and prognostic analysis of enterovesical fistula complicating Crohn's disease: a single-center retrospective study of 37 cases

@article{yuyang2026surgical,
  title = {{Surgical treatment strategies and prognostic analysis of enterovesical fistula complicating Crohn's disease: a single-center retrospective study of 37 cases}},
  author = {Zhao Yuyang and Qiu Zhuoziqi and Huang Qiapeng and Mao Ren and Song Xinming and Chen Chuangqi and Chen Zhihui},
  journal = {结直肠肛门外科},
  year = {2026},
  month = aug,
  doi = {10.19668/j.cnki.issn1674-0491.2026.04.007},
  url = {https://doi.org/10.19668/j.cnki.issn1674-0491.2026.04.007},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Surgical treatment strategies and prognostic analysis of enterovesical fistula complicating Crohn's disease: a single-center retrospective study of 37 cases
AU  - Zhao Yuyang
AU  - Qiu Zhuoziqi
AU  - Huang Qiapeng
AU  - Mao Ren
AU  - Song Xinming
AU  - Chen Chuangqi
AU  - Chen Zhihui
PY  - 2026
DA  - 2026/08/01
JO  - 结直肠肛门外科
DO  - 10.19668/j.cnki.issn1674-0491.2026.04.007
UR  - https://doi.org/10.19668/j.cnki.issn1674-0491.2026.04.007
AB  - Objectives To investigate the surgical treatment strategies and long-term prognosis of enterovesical fistula (EVF) complicating Crohn's disease, and to evaluate the feasibility of laparoscopic surgery and the efficacy of a minimized bladder-side management approach. Methods Clinical data of 37 patients with EVF complicating Crohn's disease treated at The First Affiliated Hospital, Sun Yat-sen University between January 2015 and December 2024 were retrospectively analyzed. Among them, 32 patients underwent surgical intervention. All surgical patients underwent resection of the primary intestinal lesion, while bladder-side management was individualized based on intraoperative leak test results. Baseline characteristics, surgical procedures, perioperative outcomes, and long-term prognosis of surgical patients were analyzed, along with the status of non-surgical patients. Results Among the 32 surgical patients, 24 were male and 8 were female. The fistula originated from the ileum in 24 cases and from the colon in 8 cases. Magnetic resonance imaging was the most common diagnostic modality for EVF (53.1%). Laparoscopic surgery was performed in 20 patients and open surgery in 12. Fistula division combined with bladder wall defect repair was performed in 19 patients, while fistula division alone without bladder wall defect repair was performed in 13. Prophylactic ileostomy was created in 2 patients. The median operative time was 195.0 (171.2, 281.2) min, median intraoperative blood loss was 100 (50, 100) mL, median postoperative catheterization duration was 7.0 (3.8, 13.2) days, and median postoperative hospital stay was 10.0 (7.0, 14.5) days. Five patients developed postoperative complications within 30 days. Perioperative outcomes were compared across different treatment strategies using operative time, intraoperative blood loss, postoperative catheterization duration, postoperative hospital stay, and 30-day complication rate as surgical-related variables. Regarding surgical approach, the laparoscopic group had significantly less intraoperative blood loss, shorter postoperative catheterization duration, and shorter postoperative hospital stay compared with the open surgery group (P＜0.05). Regarding bladder-side management, the bladder repair group had significantly longer operative time, greater intraoperative blood loss, and longer postoperative catheterization duration compared with the non-repair group (P＜0.05). No significant differences were observed in surgical-related variables between patients with and without preoperative biologic use (P＞0.05). The median follow-up duration for the 32 surgical patients was 36.3 (17.1, 67.2) months. During follow-up, 2 patients underwent repeat abdominal surgery due to active Crohn's disease, and no recurrence of EVF was observed. Among the 5 non-surgical patients, all received biologic therapy as the primary treatment; 2 were lost to follow-up after diagnosis, and 3 had their symptoms controlled during follow-up. Conclusion For EVF complicating Crohn's disease, a strategy centered on resection of the primary intestinal lesion with individualized bladder-side management guided by intraoperative leak test results can achieve satisfactory long-term outcomes.
SN  - 1674-0491
ER  -