Giovanni Cochetti, Emanuele Cottini, Roberto Cirocchi, Alberto Pansadoro, Emanuele Lepri, Alessia Corsi, Francesco Barillaro, Ettore Mearini
Department of Surgical Specialties, Urological Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Terni, Italy.
Wideochir Inne Tech Maloinwazyjne. 2013 Jun;8(2):162-5. doi: 10.5114/wiitm.2011.32808. Epub 2013 Jan 16.
Enterovesical fistula is a rare disease. The standard treatment of colovesical fistula is removal of the fistula, suture of the bladder wall, and colic resection with or without temporary colostomy. The usual approach is open because the laparoscopic one has high conversion rates and morbidity. We report the first laparoscopic conservative treatment of colovesical fistula in our knowledge and its long-term results. A 69-year-old man was affected by colovesical fistula due to endoscopic exeresis of a 2 cm adenomatous polyp in the sigmoid diverticulum. We performed a laparoscopic conservative treatment of the fistula without colic resection. Operative time was 210 min and estimated blood loss was 300 ml. The catheter was removed after 10 days. Time to first flatus was 2 days and the hospital stay was 8 days. No peri- or post-operative complications occurred. At 48-month follow-up fistula did not recur. Laparoscopic conservative surgery for colovesical fistula is safe and feasible. It could be a therapeutic option in selected cases, especially if diverticular disease and inflammation are slight.
膀胱结肠瘘是一种罕见疾病。结肠膀胱瘘的标准治疗方法是切除瘘管、缝合膀胱壁以及进行结肠切除术，可选择是否进行临时结肠造口术。通常采用开放手术，因为腹腔镜手术的中转率和发病率较高。我们报道了首例我们所知的腹腔镜保守治疗结肠膀胱瘘及其长期结果。一名69岁男性因乙状结肠憩室内2 cm腺瘤性息肉的内镜切除而患结肠膀胱瘘。我们对该瘘管进行了腹腔镜保守治疗，未进行结肠切除。手术时间为210分钟，估计失血量为300毫升。10天后拔除导尿管。首次排气时间为2天，住院时间为8天。未发生围手术期或术后并发症。在48个月的随访中，瘘管未复发。腹腔镜保守手术治疗结肠膀胱瘘是安全可行的。在某些特定病例中，尤其是憩室病和炎症较轻时，它可能是一种治疗选择。
