Robotic Management of Diverticular Colovaginal and Colovesical Fistulas

Colovesical and colovaginal fistulas are a complication of diverticular disease that often requires surgical intervention. Minimally invasive surgery is associated with improved postoperative outcomes, but reported laparoscopic rates of conversion to open for these patients have been relatively high. There are limited studies evaluating robotic-assisted management of these fistulas. This study aims to report our single-center experience of robotic management of such fistulas, with the primary outcome being the conversion rate to open.

All elective robotic sigmoid resections for diverticular colovaginal and colovesical fistulas performed from January 2018 to August 2023 were included. Patient demographic variables and 30-day postoperative outcomes were retrospectively collected.

Thirty-five patients were included, 21 with colovesical and 14 with colovaginal fistulas. Overall, the conversion to open rate was 8.6% (3 out of 35). All patients converted to open were patients with colovesical fistulas. Operating time (median of 354 vs 347 minutes, P = .583) and estimated blood loss (median of 100 vs 100 mL, P = .538) were similar for colovesical and colovaginal fistulas, respectively. Two patients required ostomy creation, both in the colovaginal group. Three patients in the colovesical group developed an ileus compared to one in the colovaginal group. There were 2 urinary tract infections (UTIs), both in the colovesical group. Thirty-day readmission (2 vs 1, P = .652) and length of stay (median 2 vs 2 days, P = .855) were similar for colovesical and colovaginal fistulas, respectively.

Diverticular fistulas can be managed successfully with a robotic approach and appropriate surgeon experience, having minimal morbidity or complications.