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Introduction: Vesicorectal fistula (VRF) is a rare but devastating condition that may develop after surgery or radiotherapy. Many surgical methods to treat VRF have been described, but there is still no gold standard of VRF treatment. Aim: The aim of the study is to present our experience in the treatment of VRFs and analyze different surgical techniques applied in our center retrospectively. Material and methods: From June 2016 to June 2020, 7 patients (5 males and 2 females) aged 59–73 years (average 67.3 years) were treated for VRF in our center. The primary causes of VRFs were complications after laparoscopic radical prostatectomy (LRP), sigmoidectomy, laparotomy with removal of the tumour of the vaginal stump and anterior rectal resection and colostomy, Hartmann’s operation due to rectosigmoid carcinoma, radiotherapy, treatment of cervical cancer and transurethral resection of bladder tumor (TURBT). The patients were treated with one of the following methods: transvesical laparoscopic single-site surgery (T-LESS), transanal minimally invasive surgery (TAMIS), transurethral fulguration and radical cystectomy with the Bricker’s ileal conduit. Results and discussion: Five patients underwent T-LESS, 2 TAMIS, 1 transurethral fulguration and 1 radical cystectomy with the Bricker’s ileal conduit. The mean postoperative hospital stay was 4 days (range 2–8 days). The mean operative time was 139 minutes (range 100–285 minutes). Only 1 patient had a recurrence of a fistula. Conclusions: Surgical management of VRFs is obligatory to prevent possible complications. Currently, there is no gold standard for treatment of VRFs. Therefore, this condition requires further investigation.
Introduction: Vesicorectal fistula (VRF) is a rare but devastating condition that may develop after surgery or radiotherapy. Many surgical methods to treat VRF have been described, but there is still no gold standard of VRF treatment. Aim: The aim of the study is to present our experience in the treatment of VRFs and analyze different surgical techniques applied in our center retrospectively. Material and methods: From June 2016 to June 2020, 7 patients (5 males and 2 females) aged 59–73 years (average 67.3 years) were treated for VRF in our center. The primary causes of VRFs were complications after laparoscopic radical prostatectomy (LRP), sigmoidectomy, laparotomy with removal of the tumour of the vaginal stump and anterior rectal resection and colostomy, Hartmann’s operation due to rectosigmoid carcinoma, radiotherapy, treatment of cervical cancer and transurethral resection of bladder tumor (TURBT). The patients were treated with one of the following methods: transvesical laparoscopic single-site surgery (T-LESS), transanal minimally invasive surgery (TAMIS), transurethral fulguration and radical cystectomy with the Bricker’s ileal conduit. Results and discussion: Five patients underwent T-LESS, 2 TAMIS, 1 transurethral fulguration and 1 radical cystectomy with the Bricker’s ileal conduit. The mean postoperative hospital stay was 4 days (range 2–8 days). The mean operative time was 139 minutes (range 100–285 minutes). Only 1 patient had a recurrence of a fistula. Conclusions: Surgical management of VRFs is obligatory to prevent possible complications. Currently, there is no gold standard for treatment of VRFs. Therefore, this condition requires further investigation.
Background and Objectives: Minimally invasive techniques have been introduced to decrease the morbidity related to standard laparoscopic procedures. One such approach is transvesical laparoendoscopic single-site surgery (T-LESS). We describe our clinical experience of using this technique for vesicorectal fistula (VRF) repair. Description:In October 2013, we performed the T-LESS repair of a vesicorectal fistula of 5 mm diameter in a 72-year-old man, in whom conservative treatment with temporary colostomy and Foley catheter placement had failed. The procedure was performed transvesically (percutaneous intraluminal approach) with a single-port device via a 15 mm incision made 20 mm above the pubic symphysis. Standard 10 mm optic and straight laparoscopic instruments were used. The fistulous tract was dissected and closed in two layers with a running, absorbable, barbed suture. A cystostomy tube was left in place for 22 days, and a Foley catheter for 1 week. Results:The operation lasted 155 min. Blood loss was minimal. No complications were observed. The postoperative period was uneventful. During a 5-week follow-up, the patient reported no involuntary discharge of urine into the rectum. A voiding cystourethrogram revealed no presence of VRF, and laboratory examination results were all within the normal range. The colostomy was closed after 4 months, and a 12-month follow-up confirmed the integrity of both the urinary and digestive tracts. Conclusion:Although substantial development of the instruments and skills is needed, the T-LESS VRF repair appears to be feasible and safe. Nevertheless, further experience and observations are necessary.
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