K. Tomizawa1, S. Matoba1, N. Okazaki1, K. Hiramatsu1, Y. Hanaoka1, S. Toda1, H. Kuroyanagi1, H. Kuroyanagi1 1Toranomon Hospital, Gastroenterological Surgery,Tokyo, Japan
Introduction: Colonic diverticular disease is widespread, and its incidence increases with aging. Patients suffering from diverticulitis and colovesical fistula are also increasing. Diverticular colonic resections are frequently more technically demanding than colon cancer due to inflammation. This study aimed to evaluate the safety and efficacy of our standardized laparoscopic procedure.
Methods: A retrospective analysis was reviewed of 44 consecutive patients undergoing laparoscopic surgery for colovesical fistula during the period October 2006 to July 2018.
Results:The median age was 61 years and the patients comprised 40 men and 4 women. Surgical procedures were sigmoidectomy: thirty-eight, Hartmann's operation: four, low anterior resection: two, respectively. The median operating time was 201 minutes and the estimated blood loss was 65.5mL. There were no intraoperative complications and conversion to open surgery. No bladder wall repairs were required. Six patients had minor postoperative complications comprising a postoperative abscess and three cases of superficial wound infection and three cases of anastomotic bleeding. The median length of postoperative stay was 11days. No patients had recurrence of diverticulitis or fistula at median follow-up of 5.6 years.
Conclusion:We demonstrated that laparoscopic surgery for colovesical fistula can be safely performed. Because of its minimally invasive, laparoscopic approach appears to be the ideal choice especially for the colovesical fistula. To our knowledge, this is the largest study of colovesical fistula treated with laparoscopic procedure.