Laparoscopic surgery for colovesical fistula associated with sigmoid colon diverticulitis: a review of 39 cases

Abstract

Objectives: Colonic diverticular disease is widespread in Western countries and its associated with aging. In Japan, diverticulitis and colovesical fistula are also occurring more frequently. Colonic resection for diverticula-related fistulas is frequently technically demanding because of associated acute or chronic inflammation. We evaluated the safety and efficacy of a standardized laparoscopic procedure. Methods: Data from 39 consecutive patients who had undergone laparoscopic surgery for colovesical fistula between October 2006 and August 2017 were retrospectively reviewed. Results: The patients' median age was 60 years and comprised 35 men and four women. Sigmoidectomy was performed in 33 patients, Hartmann's procedure in four, and anterior resection in two. The median operative time was 203 minutes and estimated blood loss 15 mL. There were no intraoperative complications or conversion to open surgery. No patients required bladder repair; three had minor postoperative complications, and none had recurrent diverticulitis or fistula at a mean follow-up of 5.1 years. Conclusions: The magnified vision and minimal invasiveness make a laparoscopic approach the ideal means of managing colovesical fistula. To our knowledge, this is the largest study of colovesical fistula managed by a standardized laparoscopic procedure.

Laparoscopic surgery for diverticular colovesical fistula: single-center experience of 11 cases

“…Based on these results, it could be concluded that laparoscopic surgery for diverticular CVF is safe and feasible. Several small retrospective studies on diverticular fistulas have reported that the incidence of COS ranges from 0 to 50%, [9,[11][12][13][14][15][16][17][18][19][20], and patients with a preoperative diagnosis of CVF were most likely to require COS. Recent studies on CVF by Badic et al [14] and Martinolich et al [22] reported COS incidence rates of 43% and 42%, respectively, comparable to our rate of 27%.…”

“…UTIs occurred in two patients, and ileus and pelvic abscess occurred in one each. The median timing of Foley catheter removal was postoperative day 7 (range of 3-11), and the median hospital stay was 13 days (range of [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. No reoperations or mortalities occurred (Table 1).…”

“…However, laparoscopic surgery for diverticular CVF is still technically challenging because of extensive inflammation and abscess formation. These complications may explain why the incidence of conversion to open surgery (COS) ranges from 0 to 50% [9,[11][12][13][14][15][16][17][18][19][20]. Identification of preoperative risk factors for COS is critical, as evaluating risk can help guide the decision on conversion during the surgery.…”

Laparoscopic surgery for diverticular colovesical fistula: Single–center experience of 11 cases

“…Several small retrospective studies on diverticular fistulas have reported that the incidence of COS ranges from 0 to 50%, [9,[11][12][13][14][15][16][17][18][19][20] and patients with a preoperative diagnosis of CVF were most likely to require COS. Recent studies on CVF by Badic et al [14] and Martinolich et al [22] reported COS incidence rates of 43% and 42%, respectively, comparable to our rate of 27%.…”

“…The median timing of Foley catheter removal was postoperative day 7 (range of 3-11), and the median hospital stay was 13 days (range of [8][9][10][11][12][13][14][15][16][17][18][19][20][21]. No reoperations or mortalities occurred (Table 1).…”