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Surgical morbidity and mortality rates in colovesical fistula surgery still remain high and recurrence rate can reach up to 10%. The objectives of this study were to analyze risk factors associated with morbidity and mortality in patients with colovesical fistulas.In a 20 year period, we included all the patients operated by colovesical fistula in a referral center.We included 50 patients. Most common etiologies were colonic diverticular disease (52%), cancer and radiation (22%). Surgicalprocedures wereprimary anastomosis without stoma (46%),primary anastomosis with loop ileostomy (18%), Hartmann'sprocedures (18%) andproximal stomas (18%). Overall morbidity was 32% (n = 16). Leak rate was 6.2%. Factors associated with leak were cancer (P = 0.008) and co-morbidities (P = 0.04). Factors associated with mortality were low albumin levels (P = 0.04), hypertension (P = 0.04) and use of amines (P = 0.04). Recurrence rate was 7%. Surgical morbidity rate was 33% in Hartmann's reversalprocedures and 0% in patients with loop ileostomy closures.Resectiveprocedures showed less recurrence rates. Main factors associated with anastomotic leaks and mortality were cancer, co-morbidities, low albumin levels and amines. We suggest having a low threshold to perform aproximal loop ileostomy when patientspresent with these risk factors.