Surgical management of colovesical fistulas.

BACKGROUND

The most common etiology of colovesical fistulas is complicated diverticular disease and the treatment of choice is surgical resection. There are very few reports of the application of minimally invasive approaches for these surgeries. The aim of our study was to evaluate the role of laparoscopy in this challenging surgical setting.

METHODS

A retrospective analysis of patients who underwent transabdominal surgery for colovesical fistula in 2008-2018 was performed. Patients were divided into 2 groups: patients who had open surgery and patients treated with laparoscopy. The postoperative course was reviewed for the length of stay, postoperative complications, readmission, emergency re-operation, and mortality RESULTS: Thirty-five patients were included (13 females [37%]; median age 68 [range 28-84] years) with a mean body mass index of 29 ± 7.19 kg/m. The main fistula etiology was diverticulitis (91%). Seventeen patients (48.5%) had laparoscopic surgery and 2 patients in whom laparoscopy was attempted underwent conversion to laparotomy. The benefits of laparoscopy included significant reductions in morbidity including surgical site infections and medical complications following laparoscopy.

CONCLUSIONS

Laparoscopic management of colovesical fistula is both safe and feasible in a high volume laparoscopic colorectal surgery center. Laparoscopy offers potential benefits including a decreased incidence of surgical site infections and medical complications.