Fistula formation in recurrent sigmoid diverticulitis - a domain of laparoscopic surgery?

Chronic sigmoid diverticulitis is the most common benign cause of sigmoid-bladder fistulas (SBF) and sigmoid-vaginal fistulas (SVF). This multicenter retrospective comparative study analyzed the perioperative and postoperative outcomes between laparoscopic and open surgical procedures.

The study included 101 patients from four German hospitals who underwent elective sigmoid resection for SBF, SVF, or combined fistulas between January 2010 and July 2024. Patient data were retrospectively analyzed, comparing outcomes based on the surgical approach.

Of the 101 patients, 70 (69.3%) had a sigmoid-bladder fistula, 29 (28.7%) had a sigmoid-vaginal fistula, and 2 (2%) had a combined fistula. Fifty-seven patients (56.4%) underwent open surgery, while 44 (43.6%) had laparoscopic surgery. The median hospital stay was significantly shorter in the laparoscopic group (11 days vs. 16 days, p = 0.016). The laparoscopic group also showed earlier removal of drains (4 days vs. 5.5 days, p = 0.044), shorter intensive care unit (ICU) stays (0.5 days vs. 1.5 days, p = 0.026) and earlier return of bowel function (3 days vs. 5 days, p < 0.001). No significant differences were observed in anastomotic leakage rates (1 in the laparoscopic group vs. 7 in the open group, p = 0.066), mortality rates (1 in the laparoscopic group vs. 4 in the open group, p = 0.384), wound infection rates (7 in the laparoscopic group vs. 15 in the open group, p = 0.234) and operating time (206 min in the laparoscopic group vs. 159 min in the open group p = 0.133).

Laparoscopic procedures, if technical possible, potentially demonstrate superior postoperative outcomes compared to open surgery for the treatment of fistulizing sigmoid diverticulitis in several parameters without increasing risk or operating time.