Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review

Abstract

Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.

Guidelines for Colonic Diverticular Bleeding and Colonic Diverticulitis: Japan Gastroenterological Association

“…The incidence of colovesical fistula is higher in men than in women due to the presence of the uterus between the bladder and colon. Recent studies have reported the efficacy of one-stage resection in laparoscopic surgery occasionally [168][169][170], but the presence of inflammation makes the procedure more difficult than the standard surgery for colorectal cancer. Therefore, the surgery should be performed by skilled surgeons.…”

“…Fistulas occur in 4-20% of patients with colonic diverticulitis. rence are the bladder, sigmoid colon, uterus, vagina (after hysterectomy), kidneys, and skin [152,168,169]; with the bladder and sigmoid colon having the highest rates of occurrence. Colovesical fistula very rarely closes spontaneously because the pressure in the colon is much higher than that in the bladder.…”

Selective use of cystogram following segmental bowel resection in patients with enterovesical fistula

“…In the present study, an omental interposition was performed in just over one-third of the patients. This technique may reduce the risk of recurrent fistulas by placing healthy, well-vascularized tissue over the surface of the bladder to improve healing [2,[7][8][9]. Given our low leak rates, the use of this procedure may be more Table 3 Postoperative outcomes of patients included in the study.…”

Modern management of diverticular disease in men

“…Treatment of the bladder component may involve fistulotomy with sutured or stapled repair of the bladder defect, or the bladder can be left to heal via secondary intention. 11 Surgery can be laparoscopic or open. In the first few weeks after fistula formation, friable intra-abdominal adhesions develop that greatly enhance the risk of damage to intra-abdominal organs during surgery.…”