Single-incision laparoscopic (SIL) sigmoid colectomy and uterus-preserving repair for colo-uterine fistula secondary to severe diverticular disease: an unusual technical solution for an unusual presentation of a common disease

Abstract

Colouterine fistula as a potential complication of chronic diverticulitis is a rare entity with less than 30 cases reported worldwide. Generally, patients require a multidisciplinary approach including a major laparotomy with hysterectomy and sigmoid colectomy, and, occasionally, temporary colostomy. We report the first attempt of a novel, minimally invasive technique for managing a case of benign colouterine fistula with single-incision laparoscopic (SIL) sigmoid colectomy and uterus preservation. A small, 3 cm incision site provided access for the whole operation, as well as played a role as the specimen extraction site. Malignant fistulas and large uterine defects may require hysterectomy, however, laparoscopic closure of uterine wall defects can be considered as a reasonable alternative in selected patients, avoiding the higher risks associated with hysterectomy and keeping fertility at younger ages. Single incision laparoscopy in complicated diverticular disease and fistula formation cases is a challenging but technically feasible option, in experienced hands.

Colouterine fistula: A case report of a rare complication of diverticular disease managed during the pandemic

“…Others even suggested simple percutaneous drainage of the uterus after colonic diversion Some even advocate just simply primarily suturing the colon after separating the viscera closing the uterine perforation. More surgeons prefer resection to examine the complete specimen for the purpose of diagnosing potential malignancies, both on the sigmoid and the uterine side [ [30] , [31] , [32] ]. Some authors have pointed out that fistulas involving the colon in elderly patients are more likely to be managed conservatively than in younger patients.…”

Single-incision laparoscopy surgery: a systematic review

“…The first attempt of a novel, minimally invasive technique for managing a case of benign colouterine fistula with single-incision laparoscopic (SIL) sigmoid colectomy and uterus preservation was reported. Findings showed that single-incision laparoscopy in complicated diverticular disease and fistula formation cases is a challenging but technically feasible option in experienced hands (46). The safety and efficacy of one-stage single-incision laparoscopic-assisted anorectoplasty (SILAARP) as an alternative to the conventional approach was evaluated.…”

Laparoscopic sigmoidectomy combined with uterus excision for colouterine fistula caused by sigmoid colon diverticulitis: A case report

“…In six cases, colectomy and closure of the fistula were performed (Table ). Two cases were treated laparoscopically: one by sigmoidectomy combined with closure of the fistula, and the other via low anterior resection with colostomy and fistula closure .…”

“…Uterus excision or fistula closure without uterus excision is controversial for the treatment of non‐tumorous uterine fistula. Tracy et al and Banky et al both reported successful laparoscopic colectomy and fistula closure without uterus excision . Factors related to selecting patients for fistula closure or uterus excision include the patient's age and general condition as well as the extent of the inflammation around the uterus.…”

“…Reports of laparoscopic surgical treatments for diverticulitis combined with fistula have been increasing because of technological developments and the accumulation of experience . A randomized controlled clinical trial (Sigma Trial) to compare the results from laparoscopic and open surgery for patients with Hinchey stage I sigmoid diverticulitis was conducted in Europe .…”