Treatment of colovesical fistula complicating diverticular disease in laparoscopic era:
the truth is rarely pure and never simple
EAES Academy. Rizzuto A. 07/05/22; 366531; P274
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Abstract
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ABSTRACT
Background
Colovesical fistulas (CVF) due to complicated diverticular diseases of the sigmoid colon are rare (4-20%) but account for about 60-70% of all CVF. Despite the existence in the literature of some studies on the laparoscopic management of colovesical fistulas (CVF), there is little evidence of real effectiveness and utility of minimally invasive approach to diverticular CVF compared to open surgery. Aim of the study is to evaluate the adequacy and utility of laparoscopy in the treatment of CVF complicating diverticular disease compared to open surgery.
Methods
Patients were recruited retrospectively among those who underwent surgery for CVC by diverticular diseases between 2010 and 2020. Demographic data, clinical parameters, preoperative diagnoses, operative data, postoperative data and histopathological examination were recorded prospectively.
The patients were assigned to 2 groups: the open surgery group (group A) and the laparoscopy group (group B).
Statistical analysis was carried out using the IBM SPSS Statistic 19.0 software package.
Results
Between January 2010 and December 2020, 76 patients (29 males, 47 females) underwent surgery for colovesical fistula by complicated diverticulitis.
Among the patients accrued for the study, 40 underwent laparoscopic surgery and 36 to open surgery. No statistical significance between the two groups were observed in terms of operative time (P=0.56), bladder suture (P= 0.16) and associated surgical procedures (P=0.009). Intraoperative blood loss (P= 0.04) Postoperative primary ileus (P=0.003) and median length (P<0.0001) of stay were significantly lower in the laparoscopic group.
The overall incidence of postoperative morbidity was 16.3% with differences between the two groups (P<0.0001). Mortality occurred in one patient of the Group A (overall mortality 2.6%) and was not related to surgical complications
No reoperations for postoperative complications were observed.
The median time of Foley catheter removal was not statistically different between the two cohorts (P=0.33). Two years follow up shows no fistula recurrence.
Conclusion
Laparoscopic resection and primary anastomosis should be considered a safe and feasible option for the management of CVF by diverticular disease with rates of conversion, morbidity and mortality comparable to open approach.
Patients selection and surgeon experience are the cornerstones to obtain the best results.
Keywords
Diverticular Disease, Complicated Diverticulitis, Colovesical Fistula, Laparoscopic surgery, Colorectal Surgery.
Background
Colovesical fistulas (CVF) due to complicated diverticular diseases of the sigmoid colon are rare (4-20%) but account for about 60-70% of all CVF. Despite the existence in the literature of some studies on the laparoscopic management of colovesical fistulas (CVF), there is little evidence of real effectiveness and utility of minimally invasive approach to diverticular CVF compared to open surgery. Aim of the study is to evaluate the adequacy and utility of laparoscopy in the treatment of CVF complicating diverticular disease compared to open surgery.
Methods
Patients were recruited retrospectively among those who underwent surgery for CVC by diverticular diseases between 2010 and 2020. Demographic data, clinical parameters, preoperative diagnoses, operative data, postoperative data and histopathological examination were recorded prospectively.
The patients were assigned to 2 groups: the open surgery group (group A) and the laparoscopy group (group B).
Statistical analysis was carried out using the IBM SPSS Statistic 19.0 software package.
Results
Between January 2010 and December 2020, 76 patients (29 males, 47 females) underwent surgery for colovesical fistula by complicated diverticulitis.
Among the patients accrued for the study, 40 underwent laparoscopic surgery and 36 to open surgery. No statistical significance between the two groups were observed in terms of operative time (P=0.56), bladder suture (P= 0.16) and associated surgical procedures (P=0.009). Intraoperative blood loss (P= 0.04) Postoperative primary ileus (P=0.003) and median length (P<0.0001) of stay were significantly lower in the laparoscopic group.
The overall incidence of postoperative morbidity was 16.3% with differences between the two groups (P<0.0001). Mortality occurred in one patient of the Group A (overall mortality 2.6%) and was not related to surgical complications
No reoperations for postoperative complications were observed.
The median time of Foley catheter removal was not statistically different between the two cohorts (P=0.33). Two years follow up shows no fistula recurrence.
Conclusion
Laparoscopic resection and primary anastomosis should be considered a safe and feasible option for the management of CVF by diverticular disease with rates of conversion, morbidity and mortality comparable to open approach.
Patients selection and surgeon experience are the cornerstones to obtain the best results.
Keywords
Diverticular Disease, Complicated Diverticulitis, Colovesical Fistula, Laparoscopic surgery, Colorectal Surgery.
ABSTRACT
Background
Colovesical fistulas (CVF) due to complicated diverticular diseases of the sigmoid colon are rare (4-20%) but account for about 60-70% of all CVF. Despite the existence in the literature of some studies on the laparoscopic management of colovesical fistulas (CVF), there is little evidence of real effectiveness and utility of minimally invasive approach to diverticular CVF compared to open surgery. Aim of the study is to evaluate the adequacy and utility of laparoscopy in the treatment of CVF complicating diverticular disease compared to open surgery.
Methods
Patients were recruited retrospectively among those who underwent surgery for CVC by diverticular diseases between 2010 and 2020. Demographic data, clinical parameters, preoperative diagnoses, operative data, postoperative data and histopathological examination were recorded prospectively.
The patients were assigned to 2 groups: the open surgery group (group A) and the laparoscopy group (group B).
Statistical analysis was carried out using the IBM SPSS Statistic 19.0 software package.
Results
Between January 2010 and December 2020, 76 patients (29 males, 47 females) underwent surgery for colovesical fistula by complicated diverticulitis.
Among the patients accrued for the study, 40 underwent laparoscopic surgery and 36 to open surgery. No statistical significance between the two groups were observed in terms of operative time (P=0.56), bladder suture (P= 0.16) and associated surgical procedures (P=0.009). Intraoperative blood loss (P= 0.04) Postoperative primary ileus (P=0.003) and median length (P<0.0001) of stay were significantly lower in the laparoscopic group.
The overall incidence of postoperative morbidity was 16.3% with differences between the two groups (P<0.0001). Mortality occurred in one patient of the Group A (overall mortality 2.6%) and was not related to surgical complications
No reoperations for postoperative complications were observed.
The median time of Foley catheter removal was not statistically different between the two cohorts (P=0.33). Two years follow up shows no fistula recurrence.
Conclusion
Laparoscopic resection and primary anastomosis should be considered a safe and feasible option for the management of CVF by diverticular disease with rates of conversion, morbidity and mortality comparable to open approach.
Patients selection and surgeon experience are the cornerstones to obtain the best results.
Keywords
Diverticular Disease, Complicated Diverticulitis, Colovesical Fistula, Laparoscopic surgery, Colorectal Surgery.
Background
Colovesical fistulas (CVF) due to complicated diverticular diseases of the sigmoid colon are rare (4-20%) but account for about 60-70% of all CVF. Despite the existence in the literature of some studies on the laparoscopic management of colovesical fistulas (CVF), there is little evidence of real effectiveness and utility of minimally invasive approach to diverticular CVF compared to open surgery. Aim of the study is to evaluate the adequacy and utility of laparoscopy in the treatment of CVF complicating diverticular disease compared to open surgery.
Methods
Patients were recruited retrospectively among those who underwent surgery for CVC by diverticular diseases between 2010 and 2020. Demographic data, clinical parameters, preoperative diagnoses, operative data, postoperative data and histopathological examination were recorded prospectively.
The patients were assigned to 2 groups: the open surgery group (group A) and the laparoscopy group (group B).
Statistical analysis was carried out using the IBM SPSS Statistic 19.0 software package.
Results
Between January 2010 and December 2020, 76 patients (29 males, 47 females) underwent surgery for colovesical fistula by complicated diverticulitis.
Among the patients accrued for the study, 40 underwent laparoscopic surgery and 36 to open surgery. No statistical significance between the two groups were observed in terms of operative time (P=0.56), bladder suture (P= 0.16) and associated surgical procedures (P=0.009). Intraoperative blood loss (P= 0.04) Postoperative primary ileus (P=0.003) and median length (P<0.0001) of stay were significantly lower in the laparoscopic group.
The overall incidence of postoperative morbidity was 16.3% with differences between the two groups (P<0.0001). Mortality occurred in one patient of the Group A (overall mortality 2.6%) and was not related to surgical complications
No reoperations for postoperative complications were observed.
The median time of Foley catheter removal was not statistically different between the two cohorts (P=0.33). Two years follow up shows no fistula recurrence.
Conclusion
Laparoscopic resection and primary anastomosis should be considered a safe and feasible option for the management of CVF by diverticular disease with rates of conversion, morbidity and mortality comparable to open approach.
Patients selection and surgeon experience are the cornerstones to obtain the best results.
Keywords
Diverticular Disease, Complicated Diverticulitis, Colovesical Fistula, Laparoscopic surgery, Colorectal Surgery.
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