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Campobasso D, Zizzo M, Biolchini F, Castro-Ruiz C, Frattini A, Giunta A. Laparoscopic management of colovesical fistula in different clinical scenarios. J Minim Access Surg 2024; 20:175-179. [PMID: 37148104 PMCID: PMC11095798 DOI: 10.4103/jmas.jmas_245_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/18/2022] [Accepted: 03/03/2023] [Indexed: 05/07/2023] Open
Abstract
INTRODUCTION Colovesical fistula (CVF) is a condition with various aetiologies and presentations. Surgical treatment is necessary in most cases. Due to its complexity, open approach is preferred. However, laparoscopic approach is reported in the management of CVF due to diverticular disease. The aim of this study was to analyse the management and outcome of patients with CVF of different aetiologies treated with laparoscopic approach. PATIENTS AND METHODS This was a retrospective study. We retrospectively reviewed all patients undergoing elective laparoscopic management of CVF from March 2015 to December 2019. STATISTICAL ANALYSIS USED None. RESULTS Nine patients underwent laparoscopic management of CVF. There were no intraoperative complications or conversions to open surgery. A sigmoidectomy was performed in eight cases. In one patient, a fistulectomy with sigmoid and bladder defect closure was performed. In two cases of locally advanced colorectal cancer with bladder invasion, a multi-stage procedure with temporary colostomy was chosen. In three cases, with no intraoperative leakage, we did not perform bladder suture. Four Clavien I-II complications were recorded. Two fragile patients died in the post-operative period. No patients required re-operation. At a median follow-up of 21 months (interquartile range: 6-47), none of the patients had recurrence of fistula. CONCLUSIONS CVF can be managed with laparoscopic approach by skilled laparoscopic surgeons in different clinical scenarios. Bladder suture is not necessary if leakage is absent. Informed counselling to the patient must be guaranteed concerning the risk of major complications and mortality in case of CVF due to malignant disease.
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Affiliation(s)
- Davide Campobasso
- Department of Surgical, Urology Unit, Civil Hospital of Guastalla, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
- Department of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Biolchini
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Carolina Castro-Ruiz
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
- Department of Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Frattini
- Department of Surgical, Urology Unit, Civil Hospital of Guastalla, Reggio Emilia, Italy
| | - Alessandro Giunta
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, ASMN-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
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Sotelo R, Medina LG, Husain FZ, Khazaeli M, Nikkhou K, Cacciamani GE, Landsberger H, Winter M, Hernandez A, Kaiser AM, Gill I. Robotic-assisted laparoscopic repair of rectovesical fistula after Hartmann's reversal procedure. J Robot Surg 2018; 13:339-343. [PMID: 30062640 DOI: 10.1007/s11701-018-0854-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/23/2018] [Indexed: 01/16/2023]
Abstract
The case is of a 59-year-old male with history of severe ischemic colitis following emergent intervention for a ruptured infrarenal aortic aneurysm who subsequently underwent left hemicolectomy, partial proctectomy, and Hartmann colostomy. The patient later underwent reversal of the Hartmann colostomy with diverting ileostomy. The surgery was complicated by a right ureteral and posterior bladder injury that resulted in a large rectovesical fistula involving the right hemitrigone and right ureteral orifice. An attempt to repair the rectovesical fistula at an outside facility was unsuccessful. Then, he underwent a robotic-assisted laparoscopic repair of rectovesical fistula, including simple prostatectomy, excision of rectovesical fistulous tract, rectal closure, peritoneal and omental flap interposition, bladder neck reconstruction, vesicourethral anastomosis and right ureteral reimplantation. There were no intraoperative or postoperative complications, and the patient was discharged at postoperative day 4; cystoscopy at 6-week follow-up demonstrated a successful closure of the fistula, at which time the ureteral stents were removed.
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Affiliation(s)
- R Sotelo
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - L G Medina
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - F Z Husain
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M Khazaeli
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - K Nikkhou
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - G E Cacciamani
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - H Landsberger
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - M Winter
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A Hernandez
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - A M Kaiser
- Department of Colorectal Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - I Gill
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Feigel A, Sylla P. Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis. Clin Colon Rectal Surg 2016; 29:168-180. [PMID: 28642675 PMCID: PMC5477556 DOI: 10.1055/s-0036-1580637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resection have reported equivalent conversion and morbidity rates between reoperative and non-reoperative cases, and series evaluating the impact of laparoscopy in reoperative cases have demonstrated improved short-term outcomes with laparoscopy. The data overall highlight the importance of case selection, careful preoperative preparation and planning, and the critical role of surgeons' expertise in advanced laparoscopic techniques. Challenges to the widespread adoption of minimally invasive techniques in reoperative colorectal cases include the longer learning curve and longer operative time. However, with the steady increase in adoption of minimally invasive techniques worldwide, minimally invasive surgery (MIS) is likely to continue to be applied in the management of increasingly complex reoperative colorectal cases in an effort to improve patient outcomes. In the hands of experienced MIS surgeons and in carefully selected cases, laparoscopy is both safe and efficacious for reoperative procedures in the abdomen and pelvis, with measurable short-term benefits.
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Affiliation(s)
- Amanda Feigel
- Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Patricia Sylla
- Division of Colon and Rectal Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
PURPOSE OF REVIEW Urological fistulas are an underestimated problem worldwide and have devastating consequences for patients. Many urological fistulas result from surgical complications and/or inadequate perinatal obstetric healthcare. Surgical correction is the standard treatment. This article reviews minimally invasive surgical approaches to manage urological fistulas with a particular emphasis on the robotic techniques of fistula correction. RECENT FINDINGS In recent years, many surgeons have explored a minimally invasive approach for the management of urological fistulas. Several studies have demonstrated the feasibility of laparoscopic surgery and the reproducibility of reconstructive surgery techniques. Introduction of the robotic platform has provided significant advantages given the improved dexterity and exceptional vision that it confers. SUMMARY Fistulas are a concern worldwide. Laparoscopic surgery correction has been developed through the efforts of several authors, and difficulties such as the increased learning curve have been overcome with innovations, including the robotic platform. Although minimally invasive surgery offers numerous advantages, the most successful approach remains the one with the surgeon is most familiar.
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