Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution

Martinolich, Jessica; Croasdale, David R; Bhakta, Avinash; Ata, Ashar; Chismark, A David; Valerian, Brian T.; Canete, Jonathan J.; Lee, Edward C.

doi:10.1007/s11605-018-3950-3

Cited by 33 publications

(65 citation statements)

References 21 publications

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“…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%. During laparoscopic surgery in general, previously reported risk factors for COS included old age, male sex, high BMI, and previous abdominal operations [23][24][25].…”

Section: Discussionsupporting

confidence: 88%

“…Previous studies have shown that a laparoscopic colectomy can be safely utilized for complicated diverticulitis; however, most reports were limited by exceedingly small cohorts and highly selected patients [11,[14][15][16]. Recently, a large study of 111 consecutive diverticular fistula cases with minimal exclusion was reported by Martinolich et al [22]. Although they did not refer to Clavien-Dindo classification and other diverticular fistulae, including colovaginal, coloenteric, colocutaneous, and colocolonic fistulae, that were included in their cohort, the overall incidence of postoperative complications was 26.4%.…”

Section: Discussionmentioning

confidence: 99%

“…During laparoscopic surgery in general, previously reported risk factors for COS included old age, male sex, high BMI, and previous abdominal operations [23][24][25]. Diverticular fistula cases, in particular, showed severe inflammation or dense fibrosis, impeding safe dissection, or ureteral visualization to be the most frequent reason for COS [22]. In our study, although age, BMI, and previous abdominal operations were not significantly correlated with COS, this may simply be a consequence of the small sample size.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Objective: Laparoscopic surgery for diverticular colovesical fistula (CVF) is technically challenging, and the incidence of conversion to open surgery (COS) is high. This study aimed to review our experience with laparoscopic surgery for diverticular CVF and identify preoperative risk factors for COS. Results: This was a single institution, retrospective, observational study of 11 patients (10 males and 1 female) who underwent laparoscopic sigmoid colon resection with fistula resection for diverticular CVF from 2014 to 2019. Preoperative magnetic resonance imaging (MRI) was performed to evaluate the fistula location in the bladder, patency of the rectovesical pouch (i.e., the destination of dissection procedure between sigmoid colon and bladder) and estimate the contact area between the sigmoid colon and bladder. The relationship between preoperative variables and COS incidence was analyzed between completed laparoscopy and COS groups. The overall incidence of postoperative morbidity (Clavien-Dindo classification Grade II or higher) was 36% (4/11). Severe morbidity, reoperation, and mortality were not observed. The incidence of COS was 27% (3/11). Posterior bladder fistulas were significantly associated with COS. CVFs located on the posterior bladder appears to be a risk factor for COS. Identifying risk factors for COS preoperatively could help guide the intraoperative course.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2020

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“…Previous studies have shown that a laparoscopic colectomy can be safely utilized for complicated diverticulitis; however, most reports were limited by exceedingly small cohorts and highly selected patients [11,[14][15][16]. In a recent large study of 111 consecutive diverticular fistula cases with minimal exclusion, reported by Martinolich et al [22], the overall incidence of postoperative complications was 26.4%. In our study, although the overall incidence of postoperative morbidity was as high as 36%, all were no higher than Grade II of the Clavien-Dindo classification for severe complications.…”

Section: Discussionmentioning

confidence: 99%

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

Kitaguchi

Enomoto

Ohara

et al. 2020

Preprint

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Objective: Laparoscopic surgery for diverticular colovesical fistula (CVF) is technically challenging, and the incidence of conversion to open surgery (COS) is high. The aims of this study were to review our experience with laparoscopic surgery for diverticular CVF and to identify preoperative risk factors for COS. Results: This was a single institution, retrospective, observational study of 11 patients who had undergone laparoscopic sigmoid colon resection with fistula resection for diverticular CVF from 2014 to 2019. Preoperative magnetic resonance imaging (MRI) was utilized to evaluate fistula location in the bladder, patency of the rectovesical pouch, and estimated contact area between the sigmoid colon and bladder. The relationship between preoperative variables and incidence of COS was analyzed between completed laparoscopy and COS groups. The overall incidence of postoperative morbidity (Clavien–Dindo classification Grade II or higher) was 36% (4/11). Severe morbidity, reoperation, and mortality were not observed. The incidence of COS was 27% (3/11). Posterior bladder fistulas were significantly associated with COS ( p = 0.006 ). CVFs located on the posterior bladder appears to be a risk factor for COS. Identifying the risk factors for COS preoperatively could help guide the intraoperative course.

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“…Laparoscopic surgery has been shown to be feasible for diverticular fistulas. A study by Martinolich et al [29] of 111 consecutive cases showed a high conversion rate of 34% but a significantly shorter stay of 5.8 versus 8.1 days in laparoscopy as opposed to open surgery.…”

Section: The Laparoscopic Approach Is Safermentioning

confidence: 99%

Hot Topics in Surgical Management of Acute Diverticulitiss

Binda

Papa

Persiani

et al. 2020

JGLD

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In this session different issues for the surgical management of diverticular disease DD) were considered. The first session debated about the antibiotic treatment for acute uncomplicated diverticulitis (AUD), and supports their use selectively rather than routinely in patients with AUD. The second session discussed the best surgical treatment for those patients. Open approach is a valid choice especially in acute setting, while the laparoscopic approach should be individualised according to the level of skills of the surgeon and the risk factors of the patient (such as obesity and state of health at the time of the operation). The third session debated about the peritoneal lavage and drainage, which is still a safe surgical procedure. However, it requires longer follow-up and results of other trials to draw an adequate conclusion. The last session covers the current surgical certainties in managing complicated DD: 1. urgent colectomy has higher mortality in immune-compromised patients, while in elective surgery is comparable with other populations; 2. laparoscopic peritoneal lavage (LPL) should be the choice in young/fit patients; 3. elective resection is safer in an inflammation free interval; 4. laparoscopic resection shows advantages in several outcomes (such as post-operative morbidity and lower stoma and re-operation rate); 5. in Hinchey III/fecal peritonitis, primary sigmoid resection and anastomosis (open or laparoscopic) could be proposed in young/ fit patient; 6. in case of emergency surgery, Hartmann procedure (open or laparoscopic) must be considered in critically ill/unstable patient.

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Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution

Cited by 33 publications

References 21 publications

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

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

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

Hot Topics in Surgical Management of Acute Diverticulitiss

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