Retrospective study on the feasibility and safety of laparoscopic surgery for complicated fistulizing diverticular disease in a high-volume colorectal center.
Humans
Laparoscopy
Male
Retrospective Studies
Female
Feasibility Studies
Middle Aged
Aged
Intestinal Fistula
/ surgery
Postoperative Complications
/ etiology
Hospitals, High-Volume
Adult
Colectomy
/ methods
Conversion to Open Surgery
Diverticulitis, Colonic
/ surgery
Treatment Outcome
Aged, 80 and over
Cystogram
Fistulizing diverticular disease
Laparoscopic surgery
Journal
Langenbeck's archives of surgery
ISSN: 1435-2451
Titre abrégé: Langenbecks Arch Surg
Pays: Germany
ID NLM: 9808285
Informations de publication
Date de publication:
08 Jul 2024
08 Jul 2024
Historique:
received:
25
05
2024
accepted:
26
06
2024
medline:
8
7
2024
pubmed:
8
7
2024
entrez:
8
7
2024
Statut:
epublish
Résumé
We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center. A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram. Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08). Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.
Sections du résumé
BACKGROUND
BACKGROUND
We assessed feasibility and safety of laparoscopic sigmoidectomy for complicated fistulizing diverticular disease in a tertiary care colorectal center.
METHODS
METHODS
A single-center retrospective study of patients undergoing sigmoidectomy for fistulizing diverticular disease between 2011 and 2021 was realized. Primary outcomes were rates of conversion to open surgery and severe postoperative morbidity at 30 days. Secondary outcomes included rates of postoperative bladder leaks on cystogram.
RESULTS
RESULTS
Among the 104 patients, 32.7% had previous laparotomy. Laparoscopy was the initial approach in 103 (99.0%), with 6 (5.8%) conversions to laparotomy. Clavien-Dindo grade ≥ III complication rate at 30 days was 10.6%, including two (1.9%) anastomotic leaks. The median postoperative length of stay was 4.0 days. Seven (6.7%) patients underwent reoperation, six (5.8%) were readmitted, and one (0.9%) died within 30 days. Twelve (11.5%) ileostomies were created initially, and two (1.9%) were created following anastomotic leaks. At last follow-up, 101 (97.1%) patients were stoma-free. Urgent surgeries had a higher rate of severe postoperative complications. Among colovesical fistula patients (n = 73), postoperative cystograms were performed in 56.2%, identifying two out of the three bladder leaks detected on closed suction drains. No differences in postoperative outcomes occurred between groups with and without postoperative cystograms, including Foley catheter removal within seven days (73.2% vs. 90.6%, p = 0.08).
CONCLUSIONS
CONCLUSIONS
Laparoscopic surgery for complicated fistulizing diverticulitis showed low rates of severe complications, conversions to open surgery and permanent stomas in high-volume colorectal center.
Identifiants
pubmed: 38976060
doi: 10.1007/s00423-024-03396-8
pii: 10.1007/s00423-024-03396-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
208Informations de copyright
© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Bhakta A, Tafen M, Glotzer O et al (2016) Laparoscopic sigmoid colectomy for complicated diverticulitis is safe: review of 576 consecutive colectomies. Surg Endosc 30(4):1629–1634. https://doi.org/10.1007/s00464-015-4393-5
doi: 10.1007/s00464-015-4393-5
pubmed: 26275534
Senagore AJ, Duepree HJ, Delaney CP et al (2002) Cost structure of laparoscopic and open sigmoid colectomy for diverticular disease: similarities and differences. Dis Colon Rectum 45(4):485–490. https://doi.org/10.1007/s10350-004-6225-x
Menenakos E, Hahnloser D, Nassiopoulos K et al (2003) Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbecks Arch Surg 388(3):189–193. https://doi.org/10.1007/s00423-003-0392-4
Abbass MA, Tsay AT, Abbas MA (2013) Laparoscopic resection of chronic sigmoid diverticulitis with fistula. Jsls;17(4):636 40.10.4293/108680813x13693422520512
Martinolich J, Croasdale DR, Bhakta AS et al (2019) Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution. J Gastrointest Surg; 23(5):1015 – 21.10.1007/s11605-018-3950-3
DeLeon MF, Sapci I, Akeel NY et al (2019) Diverticular Colovaginal Fistulas: What Factors Contribute to Successful Surgical Management? Dis Colon Rectum; 62(9):1079 – 84.10.1097/dcr.0000000000001445
Wen Y, Althans AR, Brady JT et al (2017) Evaluating surgical management and outcomes of colovaginal fistulas. Am J Surg;213(3):5537.10.1016/j.amjsurg.2016.11.006
Bartus CM, Lipof T, Sarwar CM et al (2005) Colovesical fistula: not a contraindication to elective laparoscopic colectomy. Dis Colon Rectum; 48(2):233 – 6.10.1007/s10350-004-0849-8
Pokala N, Delaney CP, Brady KM et al (2005) Elective laparoscopic surgery for benign internal enteric fistulas: a review of 43 cases. Surg Endosc 19(2):222–225. https://doi.org/10.1007/s00464-004-8801-5
doi: 10.1007/s00464-004-8801-5
pubmed: 15624055
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg; 240(2):205 – 13.10.1097/01.sla.0000133083.54934.ae
Cirocchi R, Arezzo A, Renzi C et al (2015) Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. Int J Surg 24Pt A:95–100. https://doi.org/10.1016/j.ijsu.2015.11.007
doi: 10.1016/j.ijsu.2015.11.007
Badic B, Leroux G, Thereaux J et al (2017) Colovesical Fistula complicating Diverticular Disease: a 14-Year experience. Surg Laparosc Endosc Percutan Tech 27(2):94–97. https://doi.org/10.1097/sle.0000000000000375
doi: 10.1097/sle.0000000000000375
pubmed: 28368961
de la Fuente Hernández N, Martínez Sánchez C, Solans Solerdelcoll M et al (2020) Colovesical Fistula: Applicability of the Laparoscopic Approach and results according to etiology. Cir Esp (Engl Ed) 98(6):336–341. https://doi.org/10.1016/j.ciresp.2019.11.011
doi: 10.1016/j.ciresp.2019.11.011
pubmed: 31980152
de Moya MA, Zacharias N, Osbourne A et al (2009) Colovesical fistula repair: is early Foley catheter removal safe? J Surg Res; 156(2):274 – 7.10.1016/j.jss.2009.03.094
Dolejs SC, Penning AJ, Guzman MJ et al (2019) Perioperative Management of Patients with Colovesical Fistula. J Gastrointest Surg; 23(9):1867 – 73.10.1007/s11605-018-4034-0
Bertelson NL, Abcarian H, Kalkbrenner KA et al (2018) Diverticular colovesical fistula: What should we really be doing? Tech Coloproctol; 22(1):31 – 6.10.1007/s10151-017-1733-6
Ferguson GG, Lee EW, Hunt SR et al (2008) Management of the bladder during surgical treatment of enterovesical fistulas from benign bowel disease. J Am Coll Surg 207(4):569–572. https://doi.org/10.1016/j.jamcollsurg.2008.05.006
Engledow AH, Pakzad F, Ward NJ et al (2007) Laparoscopic resection of diverticular fistulae: a 10-year experience. Colorectal Dis 9(7):632–634. https://doi.org/10.1111/j.1463-1318.2007.01268.x