Tratamiento laparoscópico de las fístulas colovesicales: experiencia preliminar

Background

Diverticular disease of the colon is common in the western world. After the first episode of diverticulitis, many patients benefit from medical therapy, but 10-20% develop abscesses, obstruction, or fistula.

Aim

To describe the laparoscopic treatment of sigmoidovesical fistula secondary to diverticular disease.

Material and methods

An observational, retrospective study was conducted on 10 consecutive patients within the time frame of 2011-2015 that had undergone: 1) colovesical fistula resection and primary closure of the bladder and sigmoid colon or 2) laparoscopic sigmoidectomy with the NOSE technique (transanal extraction of the specimen and colorectal anastomosis with primary closure of the bladder).

Results

Ten patients were operated on within the time frame of February 2011 and February 2015. The mean age of the patients was 60.7(49-71) years. Sigmoidectomy with primary anastomosis was performed on 4 patients and resection and primary closure on 6 patients. Surgery duration was 140.4 (80-210) min, blood loss was 195 (80-210) ml, and length of time before beginning oral diet was 4.3 (3–5) days. The drain was left in place in all the patients for 10 days and the transurethral catheter for 2 weeks. Up to the present time, none of the patients has presented with fistula recurrence or data consistent with intestinal anastomosis stricture.

Conclusions

Reports on the use of laparoscopy for the treatment of colovesical fistulas have demonstrated acceptable results. Only a few studies concentrate exclusively on colovesical fistula; in general the reports include other types of fistula (colovaginal and colocutaneous), as well. Colovesical fistula is a pathology that can be resolved safely and efficaciously through laparoscopy.