Diverticular disease complicated by colovesical and colovaginal fistulas: not so complex robotically

Area of Science:

• Gastroenterology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Fistulizing diverticulitis, though rare (2% of cases), causes significant patient morbidity.
• Surgical intervention is often necessary due to disruptive symptoms like UTIs and abnormal discharge.
• Laparoscopic approaches have limitations, including a 36% conversion rate, prompting investigation into robotic surgery.

Purpose of the Study:

• To evaluate the feasibility and outcomes of robotic surgical resection for patients with fistulizing diverticulitis.
• To assess the conversion, complication, and recurrence rates associated with robotic surgery in this patient population.

Main Methods:

• Retrospective review of consecutive patients undergoing robotic surgical resection for colovesical and/or colovaginal fistulas at Mayo Clinic Rochester (Jan 2018-June 2024).
• Exclusion criteria included Crohn's disease, colorectal cancer, isolated coloovarian fistula, and follow-up less than one month.
• Data collected included fistula type, intraoperative findings, postoperative complications, and recurrence rates.

Main Results:

• Eighty-nine patients were analyzed: 65% with colovesical, 29% with colovaginal, and 6% with both fistula types.
• No intraoperative complications occurred; one conversion (1%) was due to loss of planes.
• 30-day complication rate was 35%, with anastomotic leak (3%) and abscess (6%) being most common. Recurrence rate was 1% after a median follow-up of 16.5 months.

Conclusions:

• Robotic surgery is a feasible and safe option for treating fistulizing diverticulitis.
• The procedure is associated with acceptable complication rates and notably low conversion and recurrence rates.
• Robotic surgery offers potential advantages over laparoscopic approaches for complex fistulizing diverticulitis cases.