Laparoscopic Surgery for Colovesical Fistula Caused by Colonic Diverticulitis: A Retrospective Study at a Single Center.

Background Colovesical fistulas caused by colonic diverticulitis are relatively rare but require surgical intervention. Recent advancements have enabled laparoscopic approaches, although standard procedures are yet to be established. Objective To evaluate the safety and efficacy of laparoscopic surgery for colovesical fistula and compare outcomes with those for Hinchey I/II diverticulitis without fistulas. Methods We retrospectively reviewed 48 patients who underwent laparoscopic surgery for colonic diverticulitis from January 2015 to August 2024. Of these, nine had colovesical fistulas. Operative time, blood loss, and postoperative hospital stay were compared using Welch's t-test. Results The mean operative time was 381.2 ± 175.0 min in the fistula group and 308.1 ± 120.5 min in the non-fistula group (p = 0.262). Mean blood loss was 162.8 ± 167.4 mL and 130.8 ± 197.7 mL, respectively (p = 0.626). Mean postoperative hospital stay was 7.7 ± 1.12 days and 7.4 ± 2.27 days (p = 0.626), respectively. There were no conversions to open surgery, and no recurrences or severe complications were observed. Conclusion Laparoscopic surgery for colovesical fistula is feasible and achieves outcomes comparable to standard cases of Hinchey I/II diverticulitis. A standardized "all-in-one" laparoscopic technique can be applied even in cases with fistulas.