Management of colovesical and colovaginal diverticular fistulas Our experience and literature reviewed

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COD: 08bis_2239_AOP Categorie: ,

Tommaso Marcucci, Sandro Giannessi, Francesco Giudici, Sara Riccadonna, Agnese Gori, Francesco Tonelli

Ann Ital Chir, 2017 88, 1: 55-61
Epub Ahead of Print 3 Oct. 2014

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AIM: This study aims evaluate the effectiveness of various surgical techniques in treating diverticular fistulas, and the
safety and efficacy of the laparoscopic procedure comparing our results with those of the literature.
MATERIAL OF STUDY: This was a prospective and uncontrolled study performed at a general surgery units. Between 2005
and 2011, 16 patients (11 men, 5 women) underwent surgery for diverticular fistulas. The mean age was 70.2 (range,
35-87) years. The medical evaluation of these patients was based on symptoms and diagnostic procedures confirming the
diagnosis of diverticular fistulas. Our surgical options included one-stage, two-stage, and defunctioning procedures.
RESULTS: Out of 16 cases of diverticular fistula 14 were colovesical and 2 colovaginal. One-stage procedure was performed
in 12 patients, two-stage procedure in 3 and defunctioning colostomy in 1. The overall complication rate was
31.2%. We recorded 1 colovesical recurrent fistula. The laparoscopic surgery was performed in 4 patients, nobody was
converted to open and there were no post-operative complications and recurrence.
DISCUSSION AND CONCLUSIONS: The data show that one-stage procedure is effective in the majority of cases of diverticular
fistulas. However, the surgery of colovesical and colovaginal fistulas is often associated to high complication rates.
This is often due to the shoddy clinical conditions and long-term diverticular illness of this group of patients. At present,
the laparoscopy in an elective setting is not considered any more a contraindication in the treatment of diverticular
fistulas.

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