Surgical Outcomes in Laparoscopic vs Open Diverting Colostomy for Radiation-Related Rectovaginal Fistula

BACKGROUND Radiation-induced rectovaginal fistula (RI-RVF) is a debilitating condition occurring after radiotherapy for pelvic malignancies. Diverting colostomy is an effective procedure for improving quality of life. This study compared surgical outcomes of laparoscopic diverting colostomy with those of open surgery for RI-RVF. MATERIAL AND METHODS Data of 66 patients who developed RI-IVF after pelvic radiation for malignancies between January 2014 and December 2023 were retrospectively collected and analyzed. Twenty-eight patients received laparoscopic diverting colostomy, and 38 patients underwent open surgery. A comparison of clinical features between the 2 groups was made initially. We also assessed surgical and postoperative outcomes, according to the approach used for diverting colostomy. RESULTS The postoperative length of stay was significantly shorter in the laparoscopic group (6±2.43 days) than in the open group (8±3.33 days, P<0.01). Laparoscopic surgery was associated with shorter length of incision (P<0.01), lower pain score (P<0.01), fewer days requiring analgesics (P<0.01), and lower rate of surgical site infection (P=0.04). There were no statistically significant differences between the 2 groups in terms of surgery time, blood loss, ICU admission, and time to first flatus, defecation, or return to liquid or normal diet. CONCLUSIONS Laparoscopic diverting colostomy is feasible for patients with RI-RVF with adhesions in the peritoneal cavity. Compared with the open procedure group, the laparoscopic surgery group had a shorter length of hospital stay and lower incidence of surgical site infections. Previous surgical and radiation history is not a contraindication for laparoscopic colostomy; therefore, the laparoscopic approach can be implemented safely in patients with RI-RVF.