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Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution.
J Gastrointest Surg. 2019 05; 23(5):1015-1021.JG

Abstract

BACKGROUND

The purpose of this study was to review our experience with laparoscopic colectomy and fistula resection, evaluate the frequency of conversion to open, and to compare the perioperative courses of the complete laparoscopic and conversion groups.

METHODS

This study is a retrospective analysis of 111 consecutive adult patients with diverticular fistulae diagnosed clinically or radiographically over 11 years at a single institution. Five patients were excluded for preoperative comorbidities. The remaining 106 consecutive patients underwent minimally invasive sigmoid colectomy with primary anastomosis. Preoperative, intraoperative, and postoperative variables were collected from the colorectal surgery service database. A retrospective cohort analysis was performed between laparoscopic and converted groups.

RESULTS

Within the group, 47% had colovesical fistulas, followed by colovaginal, coloenteric, colocutaneous, and colocolonic fistulas. The overall conversion rate to laparotomy was 34.7% (n = 37). The most common reason for conversion was dense fibrosis. Mean operative time was similar between groups. Combined postoperative complications occurred in 26.4% of patients (21.4% laparoscopic and 37.8% converted, p = 0.075). Length of stay was significantly shorter in the laparoscopic group (5.8 vs 8.1 days, p = 0.014). There were two anastomotic leaks, both in the open group. There were no 30-day mortalities.

CONCLUSIONS

Laparoscopic sigmoid colectomy for diverticular fistula is safe, with complication rates comparable to open sigmoid resection. We identify a conversion rate which allows the majority of patients to benefit from minimally invasive procedures.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Martinolich J
Division of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, 47 New Scotland Avenue, MC-61, Albany, NY, 12208, USA. martinj9@amc.edu.
Croasdale DR
Division of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, 47 New Scotland Avenue, MC-61, Albany, NY, 12208, USA.
Bhakta AS
Division of Surgery, Section of Colon and Rectal Surgery, University of Kentucky, Lexington, KY, USA.
Ata A
Division of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, 47 New Scotland Avenue, MC-61, Albany, NY, 12208, USA.
Chismark AD
Division of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, 47 New Scotland Avenue, MC-61, Albany, NY, 12208, USA.
Valerian BT
Division of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, 47 New Scotland Avenue, MC-61, Albany, NY, 12208, USA.
Canete JJ
Division of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, 47 New Scotland Avenue, MC-61, Albany, NY, 12208, USA.
Lee EC
Division of Surgery, Section of Colon and Rectal Surgery, Albany Medical Center, 47 New Scotland Avenue, MC-61, Albany, NY, 12208, USA.

MeSH

AdultAgedAged, 80 and overAnastomosis, SurgicalAnastomotic LeakColectomyColon, SigmoidConversion to Open SurgeryCutaneous FistulaDiverticulitis, ColonicFemaleFistulaHumansIntestinal FistulaLaparoscopyLength of StayMaleMiddle AgedOperative TimeRetrospective StudiesTreatment OutcomeUrinary Bladder FistulaVaginal Fistula

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30251070

Citation

Martinolich, Jessica, et al. "Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution." Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, vol. 23, no. 5, 2019, pp. 1015-1021.
Martinolich J, Croasdale DR, Bhakta AS, et al. Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution. J Gastrointest Surg. 2019;23(5):1015-1021.
Martinolich, J., Croasdale, D. R., Bhakta, A. S., Ata, A., Chismark, A. D., Valerian, B. T., Canete, J. J., & Lee, E. C. (2019). Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution. Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract, 23(5), 1015-1021. https://doi.org/10.1007/s11605-018-3950-3
Martinolich J, et al. Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution. J Gastrointest Surg. 2019;23(5):1015-1021. PubMed PMID: 30251070.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Laparoscopic Surgery for Diverticular Fistulas: Outcomes of 111 Consecutive Cases at a Single Institution. AU - Martinolich,Jessica, AU - Croasdale,D Ross, AU - Bhakta,Avinash S, AU - Ata,Ashar, AU - Chismark,A David, AU - Valerian,Brian T, AU - Canete,Jonathan J, AU - Lee,Edward C, Y1 - 2018/09/24/ PY - 2018/05/15/received PY - 2018/08/23/accepted PY - 2018/9/27/pubmed PY - 2020/7/16/medline PY - 2018/9/26/entrez KW - Diverticulitis KW - Fistula KW - Laparoscopy KW - Minimally invasive KW - Sigmoid colectomy SP - 1015 EP - 1021 JF - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract JO - J Gastrointest Surg VL - 23 IS - 5 N2 - BACKGROUND: The purpose of this study was to review our experience with laparoscopic colectomy and fistula resection, evaluate the frequency of conversion to open, and to compare the perioperative courses of the complete laparoscopic and conversion groups. METHODS: This study is a retrospective analysis of 111 consecutive adult patients with diverticular fistulae diagnosed clinically or radiographically over 11 years at a single institution. Five patients were excluded for preoperative comorbidities. The remaining 106 consecutive patients underwent minimally invasive sigmoid colectomy with primary anastomosis. Preoperative, intraoperative, and postoperative variables were collected from the colorectal surgery service database. A retrospective cohort analysis was performed between laparoscopic and converted groups. RESULTS: Within the group, 47% had colovesical fistulas, followed by colovaginal, coloenteric, colocutaneous, and colocolonic fistulas. The overall conversion rate to laparotomy was 34.7% (n = 37). The most common reason for conversion was dense fibrosis. Mean operative time was similar between groups. Combined postoperative complications occurred in 26.4% of patients (21.4% laparoscopic and 37.8% converted, p = 0.075). Length of stay was significantly shorter in the laparoscopic group (5.8 vs 8.1 days, p = 0.014). There were two anastomotic leaks, both in the open group. There were no 30-day mortalities. CONCLUSIONS: Laparoscopic sigmoid colectomy for diverticular fistula is safe, with complication rates comparable to open sigmoid resection. We identify a conversion rate which allows the majority of patients to benefit from minimally invasive procedures. SN - 1873-4626 UR - https://www.unboundmedicine.com/medline/citation/30251070/Laparoscopic_Surgery_for_Diverticular_Fistulas:_Outcomes_of_111_Consecutive_Cases_at_a_Single_Institution_ DB - PRIME DP - Unbound Medicine ER -