Laparoscopic surgery for diverticular colovesical fistula: Single–center experience of 11 cases

Abstract Objective: Laparoscopic surgery for diverticular colovesical fistula (CVF) is technically challenging, and the incidence of conversion to open surgery (COS) is high. The aims of this study were to review our experience with laparoscopic surgery for diverticular CVF and to identify preoperative risk factors for COS. Results: This was a single institution, retrospective, observational study of 11 patients who had undergone laparoscopic sigmoid colon resection with fistula resection for diverticular CVF from 2014 to 2019. Preoperative magnetic resonance imaging (MRI) was utilized to evaluate fistula location in the bladder, patency of the rectovesical pouch, and estimated contact area between the sigmoid colon and bladder. The relationship between preoperative variables and incidence of COS was analyzed between completed laparoscopy and COS groups. The overall incidence of postoperative morbidity (Clavien–Dindo classification Grade II or higher) was 36% (4/11). Severe morbidity, reoperation, and mortality were not observed. The incidence of COS was 27% (3/11). Posterior bladder fistulas were significantly associated with COS ( p = 0.006 ). CVFs located on the posterior bladder appears to be a risk factor for COS. Identifying the risk factors for COS preoperatively could help guide the intraoperative course.