Combined laparoscopic and cystoscopic surgery for colovesical fistula due to colonic diverticulitis

Excerpt

The incidence of diverticular disease has been increasing in recent years. Colovesical fistula is an abnormal connection between the colon and urinary bladder, and is found in approximately 3–5% of patients with diverticulitis. The presence of colovesical fistula usually requires surgical intervention because it can cause poor quality of life, impaired renal function, and urosepsis. The standard surgical procedure for colovesical fistula consists of bowel resection and primary anastomosis or temporary colostomy with or without bladder wall resection [1, 2]. Complicated diverticular disease is a surgical challenge associated with postoperative complications. The practice guidelines of the American Society of Colon and Rectal Surgeons (ASCRS) recommend the use of the laparoscopic approach to elective colectomy for diverticulitis if expertise is available [3]. However, recent studies have reported that the conversion rates of laparoscopic surgery for colovesical fistulas were as high as 30–40% [4, 5], which indicates that laparoscopic colectomy for colovesical fistula is technically demanding. While resection of the involved colon is necessary due to the high risk of recurrence, there is no consensus on the surgical management of the bladder side of the fistula [1, 2]. The bladder side of small fistulas does not usually need any treatment, whereas larger fistulas often required fistulectomy followed by bladder wall repair. …