Laparoscopic surgery for fistulas that complicate diverticular disease

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Colovesical and colovaginal fistulas complicate 4-20% of diverticular disease cases.
• Laparoscopic surgery is typically reserved for uncomplicated diverticular disease.

Purpose of the Study:

• To assess the efficacy and effectiveness of laparoscopic surgery in treating patients with colovesical and colovaginal fistulas.
• Evaluate the technical feasibility, short-term outcomes, and effectiveness of laparoscopic treatment for these complex fistulas.

Main Methods:

• Laparoscopic surgery was performed on 18 patients (15 with colovesical, 3 with colovaginal fistulas).
• Data collected prospectively included technical aspects, short-term outcomes, and effectiveness.
• Surgical procedures included sigmoidectomies, extended left colectomies, and segmentectomies.

Main Results:

• Mean operative time was 237 minutes, with a 5.5% conversion rate and no post-operative deaths.
• Morbidity was 27.7%, including one major complication.
• Mean hospital stay was 10 days, with gastrointestinal function returning in 2.9 days.
• Follow-up over 5.1 years showed a 5.5% fistula recurrence rate and no recurrent diverticulitis.

Conclusions:

• Laparoscopic one-stage surgery for fistulas is technically feasible, safe, and associated with low morbidity.
• The effectiveness of laparoscopic surgery appears favorable compared to open procedures.
• Prospective randomized studies are required to definitively support these conclusions.