Laparoscopic Surgery for Colovesical Fistula Due to Sigmoid Colon Diverticulitis

Introduction: Colonic diverticular disease is widespread in Western countries and its incidence increases with aging. Colonic resection for diverticula-related fistulas is frequently technically demanding because of the associated acute or chronic 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 June 2018. Results: The median age was 61 years (range 32-84 years) and the patients comprised 40 men and 4 women. The most common presenting first symptom was pneumaturia (49%), followed by urinary tract infection (44%), and diverticulitis (21%). Twelve (31%) patients had history of previous abdominal surgery. Surgical procedures were sigmoidectomy: thirty-eight, Hartmann’s operation: four, low anterior resection: two, respectively. The median operating time was 201 min (range 91-587 min) and the estimated blood loss was 65.5mL (range 0-569 mL). 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 5.5 years. Conclusion: We demonstrated that laparoscopic surgery for colovesical fistula can be safely performed. The magnified vision and minimal invasiveness make a laparoscopic approach the ideal means of managing colovesical fistula. To our knowledge, this is the largest study of colovesical fistula managed by a standardized laparoscopic procedure.157_A Figure 1. Demographics of patients157_B Figure 2. The fistula was encircled with cotton tape157_C Figure 3. Divide the sigmoid colon and bladder