Colovesical Fistula: Applicability of the Laparoscopic Approach and Results According to Etiology

• Published in: Cirugia española (English ed.) 2020-06, Vol.98 (6), p.336-341
• Main Authors: de la Fuente Hernández, Noa, Martínez Sánchez, Carmen, Solans Solerdelcoll, Mireia, Hernández Casanovas, Pilar, Bollo Rodríguez, Jesús, Gaya Sopena, Josep María, Targarona Soler, Eduard
• Format: Article
• Language: English
• Subjects: Abordaje laparoscópico; Adenocarcinoma colorrectal; Adult; Aged; Aged, 80 and over; Colectomy - methods; Colon adenocarcinoma; Colovesical fistula; Complicaciones; Complications; Conversion to Open Surgery; Cystectomy - methods; Diverticulitis; Female; Fístula colovesical; Humans; Intestinal Fistula - diagnostic imaging; Intestinal Fistula - surgery; Laparoscopic approach; Laparoscopy; Male; Middle Aged; Postoperative Complications
• ISSN: 2173-5077; 2173-5077
• DOI: 10.1016/j.cireng.2020.06.002

[Display omitted] Colovesical fistulae have significant morbidity. The aim of our study was to describe a case series of benign and malignant colovesical fistulae, focusing on the viability of the laparoscopic approach. We reviewed the characteristics of 34 patients with diverticular and colon adenocarcinoma-related colovesical fistulae treated surgically from January 2001 to March 2018, 28 with elective surgery and 6 by urgent surgery. The diagnosis was established by abdominal CT scan, colonoscopy and cystoscopy. Clinically stable patients, with no retroperitoneal or bladder trigone invasion, were approached laparoscopically. There were 13 benign cases (all of them approached by sigmoidectomy), 9 performed by laparoscopy with 3 conversions. Partial cystectomy was done in 11 cases, and in two cases conservative management with urinary catheter. Five laparoscopic approaches were performed in 21 patients diagnosed with malignant colovesical fistula, with 3 conversions and 16 laparotomies. The procedures were sigmoidectomy, left colectomy, anterior resection and pelvic exenteration. All of them required partial or total cystectomy. Sixteen patients had complications, most of which were minor (Clavien-Dindo classification I–II) and with laparotomy approach. The laparoscopic approach can be feasible in well-selected and stable patients, but we have to take into consideration that the conversion rate can be high and this surgery should be performed by experienced surgeons. Las fístulas colovesicales son una entidad poco frecuente y con una incidencia precisa desconocida. El objetivo de este estudio es describir una serie de casos de pacientes intervenidos por fístula colovesical de origen benigno y maligno y valorar la aplicabilidad del abordaje laparoscópico en ambos grupos. Realizamos un estudio descriptivo de 34 pacientes intervenidos en nuestro centro entre enero de 2001 y marzo de 2018 con el diagnóstico de fístula colovesical. Se incluyen pacientes intervenidos de manera electiva (28) y de urgencia (6). Se categorizaron según el diagnóstico mediante pruebas complementarias por TC abdominal, colonoscopia y cistoscopia, y se realizó un abordaje laparoscópico en los pacientes sin infiltración del trígono vesical y plano retroperitoneal y con situación clínica favorable. En los casos con patología benigna (13) se realizaron 4 intervenciones vía laparotómica y 9 vía laparoscópica, con 3 conversiones. En todos los casos se realizó sigmoidectomía. En 11 paciente