Diverticular disease complicated by colovesical and colovaginal fistulas: not so complex robotically
- 12.05.2025
Erschienen in:
- Verfasst von
- Richard Sassun
- Annaclara Sileo
- Jyi Cheng Ng
- Giulio Mari
- Kevin T. Behm
- Sherief F. Shawki
- David W. Larson
- Erschienen in
- Surgical Endoscopy | Ausgabe 6/2025
Abstract
Introduction
Fistulizing diverticulitis occurs in only 2% of diverticular disease cases, but its symptoms, such as urinary tract infections (UTI), pneumaturia, fecaluria, or vaginal discharge, are highly disruptive to patients. Therefore, surgery is commonly recommended. Laparoscopy has been proven feasible and safe for fistulizing diverticulitis, although revealing a conversion rate of 36%. Robotic surgery might reduce the conversion rate due to advanced instrumentation and improved optics.
Methods
All consecutive patients diagnosed with diverticulitis complicated by a colovesical or/and colovaginal fistula who underwent robotic surgical resection at Mayo Clinic Rochester (January 2018-June 2024) were included. Exclusion criteria were concurrent Crohn’s disease, colorectal cancer, isolated coloovarian fistula, and less than one month of follow-up.
Results
Eighty-nine patients were included in the study: fifty-eight (65%) patients presented with a colovesical fistula, 26 (29%) patients with a colovaginal fistula, and 5 (6%) patients with both. Ureteral ICG was utilized in 44% of cases. There were no intraoperative complications and one conversion secondary to loss of planes. Fourteen (16%) and 8 (9%) received an end colostomy or a loop ileostomy, respectively. Overall, 30-days complications were 35%, with anastomotic leak and abscess occurring in 3% and 6% of cases, respectively. One patient experienced a postoperative bladder leak, managed with a Foley catheter for 14 days, leaving no sequelae. With a median follow-up of 16.5 months, one (1%) fistula recurred after 14 days.
Conclusions
Robotic surgery for fistulizing diverticulitis is feasible, with an acceptable complication rate and extremely low conversion and recurrence rates.
Graphical abstract
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- Titel
- Diverticular disease complicated by colovesical and colovaginal fistulas: not so complex robotically
- Verfasst von
-
Richard Sassun
Annaclara Sileo
Jyi Cheng Ng
Giulio Mari
Kevin T. Behm
Sherief F. Shawki
David W. Larson
- Publikationsdatum
- 12.05.2025
- Verlag
- Springer US
- Erschienen in
-
Surgical Endoscopy / Ausgabe 6/2025
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218 - DOI
- https://doi.org/10.1007/s00464-025-11754-w
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