Abstract
Background
The most common etiology of colovesical fistulas is complicated diverticular disease and the treatment of choice is surgical resection. There are very few reports of the application of minimally invasive approaches for these surgeries. The aim of our study was to evaluate the role of laparoscopy in this challenging surgical setting.
Methods
A retrospective analysis of patients who underwent transabdominal surgery for colovesical fistula in 2008–2018 was performed. Patients were divided into 2 groups: patients who had open surgery and patients treated with laparoscopy. The postoperative course was reviewed for the length of stay, postoperative complications, readmission, emergency re-operation, and mortality
Results
Thirty-five patients were included (13 females [37%]; median age 68 [range 28–84] years) with a mean body mass index of 29 ± 7.19 kg/m2. The main fistula etiology was diverticulitis (91%). Seventeen patients (48.5%) had laparoscopic surgery and 2 patients in whom laparoscopy was attempted underwent conversion to laparotomy. The benefits of laparoscopy included significant reductions in morbidity including surgical site infections and medical complications following laparoscopy.
Conclusions
Laparoscopic management of colovesical fistula is both safe and feasible in a high volume laparoscopic colorectal surgery center. Laparoscopy offers potential benefits including a decreased incidence of surgical site infections and medical complications.
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References
Woods RJ, Lavery IC, Fazio VW et al (1988) Internal fistulas in diverticular disease. Dis Colon Rectum 31:591–596
Badic B, Leroux G, Thereaux J et al (2017) Colovesical fistula complicating diverticular disease: a 14-year experience. Surg Laparosc Endosc Percutan Tech 27:94–97
Martinolich J, Croasdale DR, Bhakta AS et al (2019) Laparoscopic surgery for diverticular fistulas: outcomes of 111 consecutive cases at a single institution. J Gastrointest Surg 23(5):1015–1021
Bhakta A, Tafen M, Glotzer O et al (2016) Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies. Surg Endosc 30:1629–1634
Laurent SR, Detroz B, Detry O et al (2005) Laparoscopic sigmoidectomy for fistulized diverticulitis. Dis Colon Rectum 48:148–152
Cirocchi R, Arezzo A, Renzi C et al (2015) Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. Int J Surg 24:95–100
Dolejs SC, Penning AJ, Guzman MJ et al (2019) Perioperative management of patients with colovesical fistula. J Gastrointest Surg 23(9):1867–1873
Bahadursingh AM, Virgo KS, Kaminski DL et al (2003) Spectrum of disease and outcome of complicated diverticular disease. Am J Surg 186:696–701
Bertelson NL, Abcarian H, Kalkbrenner KA et al (2018) Diverticular colovesical fistula: what should we really be doing? Tech Coloproctol 22(1):31–36
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Hayim Gilshtein: Nothing to disclose. Shlomo Yellinek: Nothing to disclose. Joseph Maenza: Nothing to disclose. Steven D. Wexner: Nothing to disclose.
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This study was approved by the Institutional Review Board at Cleveland Clinic.
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Informed consent was obtained from all individuals participants in the study.
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Gilshtein, H., Yellinek, S., Maenza, J. et al. Surgical management of colovesical fistulas. Tech Coloproctol 24, 851–854 (2020). https://doi.org/10.1007/s10151-020-02247-0
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DOI: https://doi.org/10.1007/s10151-020-02247-0