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Touati MD, Ben Othmane MR, Belhadj A, Saïdi A, Saidani A, Chebbi F. A rare case report of an appendico-sigmoid fistula complicating untreated acute appendicitis: Unraveling complexity in diagnosis and treatment. Int J Surg Case Rep 2024; 116:109298. [PMID: 38342027 PMCID: PMC10943657 DOI: 10.1016/j.ijscr.2024.109298] [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: 12/19/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 02/13/2024] Open
Abstract
INTRODUCTION Appendiculocolonic fistulas, often arising from benign conditions like abscess-forming appendicitis, manifest subtly. This case emphasizes their rarity, intraoperative discovery during acute appendicitis, and explores diagnostic intricacies, sensitive imaging, and distinctions in managing benign versus malignant cases. CASE PRESENTATION A 23-year-old intellectually disabled patient, lacking regular medical follow-up and surgical history, presented to our emergency department with persistent right iliac fossa pain six months ago. Due to financial constraints, a CT scan was not performed despite an inflammatory syndrome, and the patient left against medical advice. Currently experiencing the same symptoms, investigations led to the diagnosis of acute appendicitis with a probable appendico-sigmoid fistula. Surgical exploration confirmed the appendico-sigmoid fistula and the presence of an uncomplicated Meckel's diverticulum. A conservative approach, including appendectomy, Meckel's diverticulum resection, and sigmoid fistula suturing, yielded favorable results. CLINICAL DISCUSSION Appendiculocolonic fistulas often arise from acute or chronic appendicitis with local abscess formation. Our case highlights the unusual progression of untreated acute appendicitis, evolving into an appendico-sigmoid fistula. While generally benign, documented cases of malignant causes, such as appendiceal cancer, exist. Diagnosis is intricate, requiring diverse methods, with abdominal CT as a sensitive imaging tool. Conservative approaches are generally recommended for benign cases. CONCLUSION Appendiculocolonic fistulas, though rare, pose a clinical challenge due to their elusive symptoms. Primarily associated with benign conditions, notably abscess-forming appendicitis, or, as in our case, untreated acute appendicitis. This case underscores the role of abdominal CT in precise diagnosis, guiding treatment decisions based on the lesion's nature.
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Affiliation(s)
- Med Dheker Touati
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia.
| | - Mohamed Raouf Ben Othmane
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Anis Belhadj
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Aymen Saïdi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Ahmed Saidani
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
| | - Faouzi Chebbi
- General Surgery Department, Mahmoud El Matri Hospital, V59M+628 Ariana, Tunisia; Faculty of Medicine of Tunis, University of Tunis El Manar, Rue de la Faculté de Médecine, R534+F9H Tunis, Tunisia
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Yan H, Wu YC, Wang X, Liu YC, Zuo S, Wang PY. Appendico-vesicocolonic fistula: A case report and review of literature. World J Clin Cases 2022; 10:3241-3250. [PMID: 35647117 PMCID: PMC9082718 DOI: 10.12998/wjcc.v10.i10.3241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/30/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Appendico-vesicocolonic fistulas and appendiceal-colonic fistulas are two kinds of intestinal and bladder diseases that are rarely seen in the clinic. To our knowledge, no more than 4 cases of appendico-vesicocolonic fistulas have been publicly reported throughout the world, and no more than 100 cases of appendiceal-colonic fistulas have been reported. Although the overall incidence is low, an early diagnosis is difficult due to their atypical initial symptoms, but these diseases still require our attention.
CASE SUMMARY Here, we report a case of a 77-year-old male patient diagnosed with an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula. The main manifestations were diarrhea and urine that contained fecal material. The diagnosis was confirmed by multiple laboratory and imaging examinations. A routine urinalysis showed red blood cells and white blood cells. Abdominal and pelvic computed tomography scans showed close adhesions between the bowels and the bladder, and fistulas could be seen. Colonoscopy and cystoscopy and some other imaging examinations clearly showed fistulas. The preoperative diagnoses were a colovesical fistula and an appendiceal-colonic fistula. The fistulas were repaired by laparoscopic surgical treatment. The diseased bowel and part of the bladder wall were removed, followed by a protective ileostomy. The postoperative diagnosis was an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula, and the pathology suggested inflammatory changes. The patient recovered well after surgery, and all his symptoms resolved.
CONCLUSION The final diagnosis in this case was a double fistula consisting of an appendico-vesicocolonic fistula combined with an appendiceal-colonic fistula.
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Affiliation(s)
- Han Yan
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Ying-Chao Wu
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Xin Wang
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Yu-Cun Liu
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Shuai Zuo
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
| | - Peng-Yuan Wang
- Department of General Surgery, Peking University First Hospital, Beijing 100032, China
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Nakamoto H, Yokota R, Namba H, Ishikawa T, Yamada K, Hosoda M, Taguchi K. A Benign Appendiceal-Colonic Fistula, Diagnosed and Managed Laparoscopically: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e925946. [PMID: 33162549 PMCID: PMC7666437 DOI: 10.12659/ajcr.925946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/28/2020] [Accepted: 09/16/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Treatment methods for appendiceal-colonic fistulas differ greatly depending on whether lesions are benign or malignant. If the tumor is malignant, appendectomy with lymph node resection (ileocecal resection or right hemicolectomy) should be performed. There is no consensus on the method of surgery for organs infiltrated by appendiceal cancer. Furthermore, there are no reported laparoscopic cases that could be prevented from over-surgery by laparoscopy examination or rapid intraoperative pathological examination. CASE REPORT A 76-year-old man presented with positive fecal occult blood. Lower endoscopy revealed a 10-mm tumor in the rectosigmoid colon accompanied by white moss. A biopsy showed inflammatory granulation and no malignancy. Fluorodeoxyglucose-positron emission tomography showed highly increased accumulation at the tip of the appendix, and the standardized uptake value max was 7.3. We suspected a benign lesion rather than appendiceal cancer with infiltration into the rectosigmoid colon; therefore, we performed laparoscopic appendectomy and wedge-shaped resection of the rectum of the sigmoid colon. An intraoperative rapid pathological examination showed no appearance of malignancy; therefore, additional resection was omitted, and an ileostomy was created in the right lower quadrant. A permanent pathological examination showed complicated appendicitis, with no appearance of malignancy. The ileostomy was closed on postoperative day 25, and the patient was discharged on postoperative day 32. CONCLUSIONS In cases where there is difficulty in identifying whether the appendiceal-colonic fistula lesion is benign or malignant, laparoscopy and intraoperative rapid pathological examination may be useful in avoiding excessive treatment.
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Al-Temimi MH, Chandrasekaran B, Agapian J, Peters WR, Wells KO. Robotic versus laparoscopic elective colectomy for left side diverticulitis: a propensity score-matched analysis of the NSQIP database. Int J Colorectal Dis 2019; 34:1385-1392. [PMID: 31230107 DOI: 10.1007/s00384-019-03334-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Robotic surgery might have an advantage over conventional laparoscopy for colonic diverticulitis. We intend to compare both approaches in the elective management of left side diverticulitis. METHODS The National Surgical Quality Improvement Program (NSQIP) database (2012-2014) was surveyed for patients undergoing elective left/sigmoid colectomy for diverticulitis. Patient demographics, co-morbidities, disease complexity, and intraoperative details were matched on propensity scores derived from logistic regression model. RESULTS We identified 441 robotic and 6584 laparoscopic cases. Mean age was 56.8 years. Mean BMI was 29.5, and 46.5% of patients were males. Low preoperative albumin (< 3.5 mg/dl, 11.1% vs. 6.8%, p = 0.003), splenectomy (0.45% vs. 0.05%, p = 0.002), and enterotomy repair (1.1% vs. 0.4%, p = 0.029) were higher in the robotic group than the laparoscopic group. Hand assistance (35.8% vs. 42.9%, p = 0.003), splenic flexure takedown (41.5% vs. 49.2%, p = 0.002), and ureteric stent placement (18.6% vs. 23.5%, p = 0.017) were less common in the robotic group than the laparoscopic group. Case-matched analysis showed that robotic surgery was associated with shorter hospital stay (3.89 ± 2.18 days vs. 4.75 ± 3.25 days, p < 0.001), lower conversion rate (7.5% vs. 14.3%, p = 0.001), and longer operative time (219.2 ± 95.6 min vs. 188.8 ± 82.3 min, p < 0.001) than laparoscopic surgery. Robotic approach was associated with lower overall morbidity in multivariate analysis (OR = 0.72, 95% CI = 0.55-0.96), but not in case-matched analysis (14.4% vs. 19.2%, p = 0.058). CONCLUSIONS Robotic surgery is associated with shorter hospital stay and lower conversion rate and may offer lower overall morbidity than laparoscopy after elective left side colectomy for diverticulitis. Controlled prospective studies are needed to confirm these findings.
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Affiliation(s)
- Mohammed H Al-Temimi
- Department of Surgery, Division of Colorectal Surgery, Baylor University Medical Center, 3409 Worth St# 640, Dallas, TX, 75246, USA. .,Department of Surgery, Kaiser Permanente Fontana Medical Center, 9961 Sierra Ave., Fontana, CA, 92335, USA.
| | - Bindupriya Chandrasekaran
- Department of Surgery, Kaiser Permanente Fontana Medical Center, 9961 Sierra Ave., Fontana, CA, 92335, USA
| | - Johan Agapian
- Department of Surgery, Riverside University Health system, 26520 Cactus Ave,, Moreno Valley, CA, 92555, USA
| | - Walter R Peters
- Department of Surgery, Division of Colorectal Surgery, Baylor University Medical Center, 3409 Worth St# 640, Dallas, TX, 75246, USA
| | - Katrina O Wells
- Department of Surgery, Division of Colorectal Surgery, Baylor University Medical Center, 3409 Worth St# 640, Dallas, TX, 75246, USA
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Double peritoneal fat flap in the treatment of an enterovesical fistula. Tech Coloproctol 2017; 22:69-70. [PMID: 29256140 DOI: 10.1007/s10151-017-1736-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
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Diagnosis and Treatments for Vesico-Enteric Fistulas: a 2017 Current Review. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0436-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review. Int J Surg 2015; 24:95-100. [PMID: 26584958 DOI: 10.1016/j.ijsu.2015.11.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/01/2015] [Accepted: 11/05/2015] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Laparoscopic surgery is considered in the treatment of diverticular fistula for the possible reduction of overall morbidity and complication rate if compared to open surgery. Aim of this review is to assess the possible advantages deriving from a laparoscopic approach in the treatment of diverticular fistulas of the colon. METHODS Studies presenting at least 10 adult patients who underwent laparoscopic surgery for sigmoid diverticular fistula were reviewed. Fistula recurrence, reintervention, Hartmann's procedure or proximal diversion, conversion to laparotomy were the outcomes considered. RESULTS 11 non randomized studies were included. Rates of fistula recurrence (0.8%), early reintervention (30 days) (2%) and need for Hartmann's procedure or proximal diversion (1.4%) did not show significant difference between laparoscopy and open technique. DISCUSSION there is still concern about which surgery in complicated diverticulitis should be preferred. Laparoscopic approach has led to less postoperative pain, shorter hospital stay, faster recovery and better cosmetic results. Laparoscopic resection and primary anastomosis is a possible approach to sigmoid fistulas but its advantages in terms of lower mortality rate and postoperative stay after colon resection with primary anastomosis should be interpreted with caution. When there is firm evidence supporting it, it is likely that minimally invasive surgery should become the standard approach for diverticular fistulas, thus achieving adequate exposure and better visualization of the surgical field. CONCLUSION The lack of RCTs, the small sample size, the heterogeneity of literature do not allow to draw statistically significant conclusions on the laparoscopic surgery for fistulas despite this approach is considered safe.
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Tobias-Machado M, Mattos PAL, Reis LO, Juliano CAB, Pompeo ACL. Transanal Minimally Invasive Surgery (TAMIS) to Treat Vesicorectal Fistula: A New Approach. Int Braz J Urol 2015; 41:1020-1026. [PMID: 26689530 PMCID: PMC4756981 DOI: 10.1590/s1677-5538.ibju.2014.0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/08/2014] [Indexed: 11/22/2022] Open
Abstract
PURPOSE Vesicorectal fistula is one of the most devastating postoperative complications after radical prostatectomy. Definitive treatment is difficult due to morbidity and recurrence. Despite many options, there is not an unanimous accepted approach. This article aimed to report a new minimally invasive approach as an option to reconstructive surgery. MATERIALS AND METHODS We report on Transanal Minimally Invasive Surgery (TAMIS) with miniLap devices for instrumentation in a 65 year old patient presenting with vesicorectal fistula after radical prostatectomy. We used Alexis® device for transanal access and 3, 5 and 11 mm triangulated ports for the procedure. The surgical steps were as follows: cystoscopy and implant of guide wire through fistula; patient at jack-knife position; transanal access; Identification of the fistula; dissection; vesical wall closure; injection of fibrin glue in defect; rectal wall closure. RESULTS The operative time was 240 minutes, with 120 minutes for reconstruction. No perioperative complications or conversion were observed. Hospital stay was two days and catheters were removed at four weeks. No recurrence was observed. CONCLUSIONS This approach has low morbidity and is feasible. The main difficulties consisted in maintaining luminal dilation, instrumental manipulation and suturing.
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Affiliation(s)
- Marcos Tobias-Machado
- Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Seção de Uro-oncologia, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Pablo Aloisio Lima Mattos
- Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Leonardo Oliveira Reis
- Divisão de Urologia da Faculdade de Ciências Médicas da Universidade de Campinas, UNICAMP, Campinas, Brasil
- Faculdade de Medicina - Divisão de Urologia do Centro de Ciências da Vida, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Brasil
| | - César Augusto Braz Juliano
- Programa de Cirurgia Urológica Minimamente Invasiva, Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Urologia, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
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Hidaka E, Nakahara K, Maeda C, Takehara Y, Ishida F, Kudo SE. Laparoscopic surgery for sigmoidocutaneous fistula due to diverticulitis: A case report. Asian J Endosc Surg 2015; 8:340-2. [PMID: 26303733 DOI: 10.1111/ases.12189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/09/2015] [Indexed: 11/29/2022]
Abstract
Sigmoidocutaneous fistulas due to sigmoid colon diverticulitis are very rare. Here we report a case in which laparoscopic sigmoidectomy was used to successfully treat a sigmoidocutaneous fistula due to diverticulitis. A 41-year-old man was admitted to our hospital because of redness and swelling of the left inguinal skin. Enhanced abdominal CT revealed a subcutaneous abscess in the left lower abdomen. Percutaneous drainage was performed, and fistulography revealed a fistula between the sigmoid colon and left inguinal skin. Therefore, a sigmoidocutaneous fistula was diagnosed, and laparoscopic sigmoidectomy and fistulectomy were performed. The sigmoid colon had several diverticula, and a pathological examination revealed that the sigmoidocutaneous fistula was due to diverticulitis. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. In cases of sigmoidocutaneous fistula, laparoscopic treatment can be safely performed.
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Affiliation(s)
- Eiji Hidaka
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Kenta Nakahara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Chiyo Maeda
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Yusuke Takehara
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Fumio Ishida
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
| | - Shin-ei Kudo
- Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan
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Laparoscopic management of diverticular colovesical fistula: experience in 15 cases and review of the literature. Int Surg 2014; 98:101-9. [PMID: 23701143 DOI: 10.9738/intsurg-d-13-00024.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Colovesical fistulas secondary to diverticular disease may be considered a contraindication to the laparoscopic approach. The feasibility of laparoscopic management of complicated diverticulitis and mixed diverticular fistulas has been demonstrated. However, few studies on the laparoscopic management of diverticular colovesical fistulas exist. A retrospective analysis was performed of 15 patients with diverticular colovesical fistula, who underwent laparoscopic-assisted anterior resection and bladder repair. Median operating time was 135 minutes and median blood loss, 75 mL. Five patients were converted to an open procedure (33.3%) with an associated increase in hospital stay (P = 0.035). Median time to return of bowel function was 2 days and median length of stay, 6 days. Overall morbidity was 20% with no major complications. There was no mortality. There was no recurrence during median follow-up of 12.4 months. These results suggest that laparoscopic management of diverticular colovesical fistulas is both feasible and safe in the setting of appropriate surgical expertise.
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Cirocchi R, Cochetti G, Randolph J, Listorti C, Castellani E, Renzi C, Mearini E, Fingerhut A. Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review. Tech Coloproctol 2014; 18:873-85. [PMID: 24848529 DOI: 10.1007/s10151-014-1157-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 04/13/2014] [Indexed: 12/19/2022]
Abstract
Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.
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Affiliation(s)
- R Cirocchi
- Department of General and Oncologic Surgery, St. Maria Hospital, University of Perugia, Località Sant'Andrea delle Fratte, Via Gambuli n.1, 06156, Perugia, Italy
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Laparoscopic conservative treatment of colo-vesical fistulas following trauma and diverticulitis: report of two different cases. Open Med (Wars) 2013. [DOI: 10.2478/s11536-013-0195-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Abstract
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Golabek T, Szymanska A, Szopinski T, Bukowczan J, Furmanek M, Powroznik J, Chlosta P. Enterovesical fistulae: aetiology, imaging, and management. Gastroenterol Res Pract 2013; 2013:617967. [PMID: 24348538 PMCID: PMC3857900 DOI: 10.1155/2013/617967] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 10/29/2013] [Indexed: 12/26/2022] Open
Abstract
Background and Study Objectives. Enterovesical fistula (EVF) is a devastating complication of a variety of inflammatory and neoplastic diseases. Radiological imaging plays a vital role in the diagnosis of EVF and is indispensable to gastroenterologists and surgeons for choosing the correct therapeutic option. This paper provides an overview of the diagnosis of enterovesical fistulae. The treatment of fistulae is also briefly discussed. Material and Methods. We performed a literature review by searching the Medline database for articles published from its inception until September 2013 based on clinical relevance. Electronic searches were limited to the keywords: "enterovesical fistula," "colovesical fistula" (CVF), "pelvic fistula", and "urinary fistula". Results. EVF is a rare pathology. Diverticulitis is the commonest aetiology. Over two-thirds of affected patients describe pathognomonic features of pneumaturia, fecaluria, and recurrent urinary tract infections. Computed tomography is the modality of choice for the diagnosis of enterovesical fistulae as not only does it detect a fistula, but it also provides information about the surrounding anatomical structures. Conclusions. In the vast majority of cases, this condition is diagnosed because of unremitting urinary symptoms after gastroenterologist follow-up procedures for a diverticulitis or bowel inflammatory disease. Computed tomography is the most sensitive test for enterovesical fistula.
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Affiliation(s)
- Tomasz Golabek
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
| | - Anna Szymanska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Ulica Jaczewskiego 8, 20-954 Lublin, Poland
| | - Tomasz Szopinski
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
| | - Jakub Bukowczan
- Department of Endocrinology and Diabetes, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
| | - Mariusz Furmanek
- Department of Radiology, Central Clinical Hospital Ministry of Interior in Warsaw, ul. Wolowska 137, 02-507 Warsaw, Poland
| | - Jan Powroznik
- The 1st Department of Urology, Postgraduate Medical Education Centre, European Health Centre in Otwock, ul. Borowa 14/18, 05-400 Otwock, Poland
| | - Piotr Chlosta
- Department of Urology, Collegium Medicum of the Jagiellonian University, Ulica Grzegorzecka 18, 31-531 Cracow, Poland
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[Laparoscopic repair of enterovesical fistula in patient affected by left megaureter]. Urologia 2013; 80 Suppl 22:35-8. [PMID: 23341198 DOI: 10.5301/ru.2013.10618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Enterovesical fistula (EVF) is an abnormal communication between the intestine and the bladder. We present the case of EVF secondary to diverticular disease in a male with congenital megaureter. A laparoscopic repair of the colon vesical fistula was performed with colon resection. MATERIALS AND METHODS With the patient in the Trendelenburg position -30° degrees on the right side, 5 trocars are positioned trans-peritoneally. The exploration of the abdominal cavity shows the sigmoid diverticular disease adhering tenaciously to the posterior wall of the bladder. The intestinal loops are medialized. The inferior mesenteric vein is isolated, clipped and divided. The mesosigma is isolated and the inferior mesenteric artery is closed 2 cm from its emergence from the aorta with EndoGIA™ 45 stapler. The left colon is isolated from its splenic flexure to the mesorectum. The peritoneum between the bladder and sigmoid colon at the site of the tenacious adhesions is incised. The left megaureter is isolated from the diverticular disease and the bladder is opened on the site of the fistula, to permit a wide resection of the fistula. The posterior wall of the bladder is then closed with double running sutures. Section of the rectum with EndoGIA™ 45 stapler. Extraction of 20 cm of sigma comprising diverticular disease by a 5 cm suprapubic laparotomy. The sigma is cut and the proximal head of the circular stapler is inserted and closed with a running suture. The left colon is put back in place into the peritoneal cavity. The laparotomy is closed and the surgery is reconverted into laparoscopy. A colorectal end-to-end anastomosis according to Knight Griffen is performed with ILS 29 circular stapler. The anastomosis is tested for leakage with hydropneumatic test: no evidence of spillage. A laminar drainage is placed close to the anastomosis and the incisions are closed. RESULTS The operative time was 240 minutes. There were no intra- or post-operative complications. The bladder catheter was removed on day 7 after cystography. The patient was discharged asymptomatic on the 8th post-operative day. CONCLUSIONS Laparoscopic treatment of enterovesical fistulas for benign disease is a safe and standardized procedure. It remains a difficult procedure with a conversion rate higher than laparoscopy for uncomplicated diverticulitis or malignancy. The procedure in a single session with intracorporeal bowel anastomosis is the standard.
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Adler J, Punglia DR, Dillman JR, Polydorides AD, Dave M, Al-Hawary MM, Platt JF, McKenna BJ, Zimmermann EM. Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn's disease. Inflamm Bowel Dis 2012; 18:849-56. [PMID: 21710535 DOI: 10.1002/ibd.21801] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 05/20/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND It has become commonplace to categorize small intestinal Crohn's disease (CD) as "active" vs. "inactive" or "inflammatory" vs. "fibrotic" based on computed tomography enterography (CTE) findings. Data on histologic correlates of CTE findings are lacking. We aimed to compare CTE findings with histology from surgically resected specimens. We tested the hypothesis that CTE findings can distinguish tissue inflammation from fibrosis. METHODS Patients who underwent CTE within 3 months before intestinal resection for CD were retrospectively studied. Radiologists blinded to history and histology scored findings on CTE. Pathologists blinded to history and imaging scored resected histology. We compared histology with CTE findings and radiologists assessment of whether the stricture was likely "active" or "inactive." RESULTS In all, 22 patients met inclusion criteria. Inflammatory CTE findings correlated with histologic inflammation (rho = 0.52). Strictures believed to be "active" on CTE were more inflamed at histology (P = 0.0002). Strictures lacking inflammatory findings on CTE or considered "inactive" were not associated with greater histologic fibrosis or significant histologic inflammation. Upstream dilation was associated with greater tissue fibrosis in univariate (P = 0.014) but not in multivariate analysis (P = 0.53). Overall, histologic fibrosis correlated best with histologic inflammation (rho = 0.52). Strictures on CTE with the most active disease activity also had the most fibrosis on histology. CONCLUSIONS CTE findings of mesenteric hypervascularity, mucosal hyperenhancement, and mesenteric fat stranding predict tissue inflammation. However, small bowel stricture without CTE findings of inflammation does not predict the presence of tissue fibrosis. Therefore, caution should be used when using CTE criteria to predict the presence of scar tissue.
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Affiliation(s)
- Jeremy Adler
- Division of Pediatric Gastroenterology, Department of Pediatrics and Communicable Diseases, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
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Recurrent Urinary Tract Infections due to Asymptomatic Colonic Diverticulitis. Case Rep Med 2012; 2012:934168. [PMID: 22454651 PMCID: PMC3295588 DOI: 10.1155/2012/934168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/11/2011] [Indexed: 11/21/2022] Open
Abstract
Colovesical fistula is a common complication of diverticulitis. Pneumaturia, fecaluria, urinary tract infections, abdominal pain, and dysuria are commonly reported. The authors report a case of colovesical fistula due to asymptomatic diverticulitis, and they emphasize the importance of deeply investigate recurrent urinary tract infection without any bowel symptoms. They also briefly review the literature.
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Hirata T, Yokomizo H, Kimura Y, Nakasima M, Yamada K, Tanaka E, Hayashi K, Yamane T. Clinical Study of 5 Cases of Colon Diverticulitis with Colovesical Fistula Treated Laparoscopically. ACTA ACUST UNITED AC 2011. [DOI: 10.5833/jjgs.44.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Etienney I, Rabahi N, Cuenod CA, Hoffmann P, Charachon A, Bauer P. Fibrin glue sealing in the treatment of a recto-urethral fistula in Crohn's disease: a case report. ACTA ACUST UNITED AC 2010; 33:1094-7. [PMID: 19477614 DOI: 10.1016/j.gcb.2009.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/11/2009] [Accepted: 03/13/2009] [Indexed: 11/27/2022]
Abstract
Recto-urethral fistulas in Crohn's disease are rare, and managing them is difficult. The various surgical techniques are not reliably effective and are associated with a significant risk of morbidity. The rectal mucosal transposition flap technique, which is used most frequently, requires the rectal mucosa to be in a healthy condition. We report here on a case where treatment was by injecting fibrin glue into a complex fistula with a single anorectal point of origin but combining a median recto-urethrocutaneous tract with two deep lateral rectoperineal tracts. The patient had presented with active rectal Crohn's disease. This treatment produced complete closure, verified by MRI, of all the fistula tracts, which was still maintained after three years, and with normal anal continence. When confronted with this type of fistula, and particularly when the condition of the rectal mucosa is poor, the specialist should be encouraged by this good result to consider the injection of fibrin glue, a technique without risk of morbidity, as a first course of action.
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Affiliation(s)
- I Etienney
- Service de proctologie médico-interventionnelle, groupe hospitalier Diaconesses Croix-Saint-Simon, 18 rue du Sergent Bauchat, Paris, France.
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Kaidar-Person O, Rosenthal RJ, Wexner SD, Szomstein S, Person B. Compression anastomosis: history and clinical considerations. Am J Surg 2008; 195:818-26. [PMID: 18367149 DOI: 10.1016/j.amjsurg.2007.10.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 09/23/2007] [Accepted: 10/10/2007] [Indexed: 12/26/2022]
Abstract
BACKGROUND Despite the fact that the concept of compression anastomosis has been investigated for nearly 2 centuries, it has not yet achieved widespread acceptance. The aim of the current report is to review the literature regarding compression anastomoses. DATA SOURCES A multi-database search was conducted using PubMed, Ovid, and the Cochrane Databases (all until June 2007), in addition to electronic links to related articles and references of selected articles. The following terms were used for the search in various combinations: anastomosis, anastomoses, sutureless, compression, nickel-titanium; Nitinol; CAC; CAR; AKA-2, Valtrac biofragmentable anastomotic ring, BAR. Language restrictions were not applied. CONCLUSIONS The various methods of compression anastomosis have been shown to be at least comparable to the standard techniques of suturing and stapling. The measurement of outcomes, including cost, safety, and efficacy of treatment, indicated that compression anastomosis can save time, is cost-effective, and offers an acceptable cost/benefit ratio compared to both stapled and sutured anastomoses. However, compression anastomosis did not gain worldwide popularity.
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Affiliation(s)
- Orit Kaidar-Person
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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TAKABA T, MORIYAMA J, YOKOYAMA T, MATOBA S, SAWADA T. FIVE CASES OF DIVERTICULITIS WITH COLOVESICAL FISTULA TREATED BY LAPAROSCOPIC SURGERY. ACTA ACUST UNITED AC 2008. [DOI: 10.3919/jjsa.69.614] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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22
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Mabrut JY, Buc E, Zins M, Pilleul F, Bourreille A, Panis Y. Prise en charge thérapeutique des formes compliquées de la diverticulite sigmoïdienne (abcès, fistule et péritonite). ACTA ACUST UNITED AC 2007; 31:27-33. [DOI: 10.1016/s0399-8320(07)91949-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Wexner SD. Editorial. Ann Surg 2006. [DOI: 10.1097/01.sla.0000197286.09217.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Laparoscopic techniques have revolutionized management of colorectal diseases; however, inflammatory diseases of the intestine have proven challenging because of the technical demands of their nature. Intense investigation and subsequent refinements in technique and technology have recently led to considerable advances and a clear role for laparoscopic management of Crohn's disease. and diverticulitis; laparoscopy for ulcerative colitis has not proven as promising. Laparoscopic procedures for ulcerative colitis require a significant learning curve. Although numerous experienced laparoscopic teams have documented their ability to complete them, long operative times and elevated rates of morbidity in some studies appear to counter the advantages. The question remains as to the universal application and appropriateness of these procedures in surgical management of ulcerative colitis.
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Affiliation(s)
- Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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25
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Laurent SR, Detroz B, Detry O, Degauque C, Honoré P, Meurisse M. Laparoscopic sigmoidectomy for fistulized diverticulitis. Dis Colon Rectum 2005; 48:148-52. [PMID: 15690672 DOI: 10.1007/s10350-004-0745-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE Nowadays laparoscopic colorectal surgery has demonstrated its advantages, including reduced postoperative pain, decreased duration of ileus, and shorter hospital stay. Few studies report results of laparoscopic surgery in complicated diverticulitis. This study was designed to analyze the results of laparoscopic sigmoidectomy in patients with fistulized sigmoiditis. METHODS The authors retrospectively reviewed 16 patients who had laparoscopic sigmoidectomy for fistulized diverticulitis between 1992 and 2003 in a series of 247 laparoscopic colectomies. Eleven patients presented with colovesical, four with colovaginal, and one with colocutaneous fistulas; all were caused by sigmoiditis. The procedure always consisted of celioscopic sigmoidectomy with stapled transanal suture and, when indicated, closure of the cystic or vaginal fistula orifice. RESULTS Mean age was 60 (range, 39-78) years. Mean number of episodes of diverticulitis before operation was three (range, 1-5). Mean time between the last episode and operation was 46 (range, 2-250) weeks. In our first three years of experience, three cases (18.7 percent) were converted to laparotomy. Reasons for conversion were the necessity for intestinal resection, splenectomy, and a wound of the anterior rectum. The mean operative time was 172 (range, 100-280) minutes. Mean hospital stay was 5.7 (range, 3-12) days. There was no mortality. Postoperative morbidity (2 patients, 12.5 percent) consisted of one pulmonary infection and one splenectomy. Long-term follow-up revealed no recurrence of diverticulitis and one incisional hernia. CONCLUSIONS In experienced hands, laparoscopic sigmoidectomy may be a safe and effective procedure for fistulized sigmoiditis.
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Affiliation(s)
- S R Laurent
- Department of Abdominal Surgery, CHU Sart Tilman B35, Liège, Belgium
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26
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Pokala N, Delaney CP, Brady KM, Senagore AJ. Elective laparoscopic surgery for benign internal enteric fistulas: a review of 43 cases. Surg Endosc 2004; 19:222-5. [PMID: 15624055 DOI: 10.1007/s00464-004-8801-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2004] [Accepted: 08/10/2004] [Indexed: 12/21/2022]
Abstract
BACKGROUND Laparoscopic surgery has been applied to the management of various colorectal conditions, with shorter recovery periods than reported for open surgery. This study reviewed the feasibility and outcome of laparoscopic surgery for benign internal enteric fistulas. METHODS All the patients undergoing laparoscopic surgery for colovesical, colovaginal, enterovesical, and enterocolic fistulas caused by diverticulitis or Crohn's disease from 1995 to 2003 were identified from the prospective laparoscopic surgery database and retrospectively analyzed. Crohn's ileo-ileal fistulas were excluded from the study because these are generally resected more simply en bloc with the terminal ileum. RESULTS This study enrolled 43 patients (23 men and 20 women) with median age of 43 years, a mean body mass index of 24.5, and in American Society of Anesthesiology (ASA) distribution of 3/33/8/0 (class 1/2/3/4). The diagnosis was diverticular for 24 patients and Crohn's disease for 19 patients. The mean operative time was 163 +/- 80 min (155 in completed and 180 in converted cases), and the mean length of hospital stay was 5.2 +/- 4.7 days (3.9 in completed and 7.9 days in converted cases). A total of 14 patients (32.6%) required conversion for dense adhesions (n = 8), duodenal involvement (n = 3), multiple fistulae (n = 1), fecal leak (n = 1), and additional pathology (n = 1). Conversion rates, analyzed by fistula type, were duodenal (100%), vaginal (66.7%), sigmoid (27.7%), bladder (15.4%), enterocolic (0%), and colocolic (0%). There were six major complications (14%) including anastomotic leak (n = 3), abscesses (n = 2), and postoperative bleeding (n = 1). There were seven minor complications (16.3%) including postoperative ileus (n = 2), transient pleural effusion (n = 1), wound infection (n = 1), transient small bowel obstruction (n = 2), and brachial plexus neuralgia (n = 1). There was no significant difference in the complication (p = 0.57), reoperation (p = 0.3), or readmission (p = 0.4) rates between the completed and converted cases. CONCLUSIONS Laparoscopic surgery for benign internal enteric fistula offers the earlier recovery seen with other laparoscopic colorectal operations. Duodenal and vaginal involvement by the fistula is associated with a higher conversion rate. A low threshold toward early conversion is useful in these difficult cases to reduce delays in the operating room and the unnecessary use of hospital resources.
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Affiliation(s)
- N Pokala
- Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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27
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Abstract
Laparoscopy surgery has achieved wide acceptance for the treatment of benign disease of the colon. A review of the literature regarding the indications, surgical technique, and outcomes of laparoscopic surgery for diverticular disease is presented.
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Affiliation(s)
- Sergio Larach
- Department of Surgery, Colon and Rectal Disease Center, University of Florida, Orlando, FL 32804, USA.
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28
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Regan JP, Salky BA. Laparoscopic treatment of enteric fistulas. Surg Endosc 2003; 18:252-4. [PMID: 14691702 DOI: 10.1007/s00464-003-8904-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2003] [Accepted: 07/28/2003] [Indexed: 12/16/2022]
Abstract
BACKGROUND Elective laparoscopically assisted sigmoid colectomy for diverticular disease and ileocolic resection for terminal ileal Crohn's disease are safe and beneficial procedures in many patients. However, few data exist regarding the laparoscopic management of enteric fistulas from diverticular and Crohn's disease. METHODS We completed a retrospective chart review of patients who underwent laparoscopic treatment of enteric fistulas complicating diverticular and Crohn's disease. RESULTS During an 8-year period (1994-2002), 72 patients underwent 73 laparoscopically assisted bowel resections for enteric fistulas by one surgeon at the Mount Sinai Medical Center. Ninety percent of patients had Crohn's disease, the average age was 39, and the male/female ratio was 38/34. Patients had a history of prior abdominal surgery in 39.7% of cases. Multiple fistulas were present in 30% of patients and 12.3% underwent multiple resections at the time of operation. Mean operating time was 199 min, and the conversion rate was 4.1%. Average length of stay was 5.2 days. There were no mortalities in the series. Overall morbidity was 11%. CONCLUSIONS Laparoscopic management of enteric fistula disease is safe and effective. Low morbidity and short hospital stay demonstrate the safety and benefit of the minimally invasive approach for even complicated fistula disease in patients with history of prior abdominal surgery and multiple fistulas, or in patients requiring multiple resections for fistulas from diverticular and Crohn's disease.
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Affiliation(s)
- J P Regan
- Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1103, New York, NY 10029-6574, USA.
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Menenakos E, Hahnloser D, Nassiopoulos K, Chanson C, Sinclair V, Petropoulos P. Laparoscopic surgery for fistulas that complicate diverticular disease. Langenbecks Arch Surg 2003; 388:189-93. [PMID: 12836027 DOI: 10.1007/s00423-003-0392-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 05/21/2003] [Indexed: 01/27/2023]
Abstract
BACKGROUND Diverticular disease is complicated by colovesical and colovaginal fistulas in 4-20% of patients. Laparoscopic surgery is usually reserved for selected cases of uncomplicated disease. The aim of this study was to assess the efficacy and effectiveness of laparoscopic surgery in the treatment of those patients. METHODS Eighteen patients, 15 with colovesical fistulas and three with colovaginal fistulas, were operated on laparoscopically. Prospectively collected data, associated with technical feasibility, short-term outcome and effectiveness, were analysed. RESULTS Twelve sigmoidectomies, four extended left colectomies and two segmentectomies were performed. Fistulas were treated with simple dissection or mechanical division, and the bladder wall was repaired in two patients. Mean operating time was 237 min (range 165-330). There was one conversion (5.5%) and no post-operative death. Morbidity was 27.7% and included one major complication. Return of gastrointestinal function occurred 2.9 days post-operatively, and the mean hospital stay was 10 days after surgery. During the 5.1-year follow-up period there was one fistula recurrence (5.5%) and no recurrent diverticulitis. CONCLUSIONS Laparoscopic one-stage surgery was technically feasible and safe, with low morbidity. Effectiveness appears favourable when compared with open surgery, but prospective randomized studies are necessary to support such a conclusion.
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Affiliation(s)
- Evangelos Menenakos
- Department of General Surgery, Hôpital Cantonal de Fribourg, Fribourg, Switzerland.
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Ignjatovic D, Bergamaschi R. What role, if any, for laparoscopic surgery in Crohn's disease of the hindgut? ACTA CHIRURGICA IUGOSLAVICA 2003; 49:9-12. [PMID: 12587460 DOI: 10.2298/aci0202009i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
An outsider to the field of surgery would probably take it for granted that surgeons have a highly developed rationale for choosing a laparoscopic approach to Crohns disease. After all, an increasing number of surgeons are performing laparoscopic surgery for Crohns disease as witnessed by several articles published in the 1990s (Table). In fact this is not quite true. Most papers are case reports or series without controls, capable only of suggesting feasibility. Furthermore, comparison studies often feature selection flaws, and therefore beg the question of whether laparoscopic surgery should or not be considered as standard care. An attempt is made herein to give readers a concise insight of the evidence available in the English language literature. It does not pretend to offer a comprehensive review of the topic rather, it highlights some relevant issues, and then outlines what role, if any, laparoscopic surgery should play in Crohn's disease. There are at least 6 categories for discussion.
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Affiliation(s)
- D Ignjatovic
- University of Dergen, Forde Health System, Forde, Norway
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Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H. Minilaparotomy approach to terminal ileal Crohn's disease. World J Surg 2002; 26:721-5. [PMID: 12053226 DOI: 10.1007/s00268-002-6217-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The feasibility and safety of a minilaparotomy approach to terminal ileal Crohn's disease have not been fully elucidated. The purpose of this study was to compare early outcomes utilizing this technique as an alternative to conventional approaches. Nine patients with terminal ileal Crohn's disease (but no complicating enteric fistulas) who underwent minilaparotomy between January 1998 and September 2000 were studied prospectively. The minilaparotomy approach entails a complete surgical procedure performed through a skin incision of less than 7 cm. Ten similar patients who underwent conventional laparotomy between January 1995 and December 1997 served as the control group. Age, gender, body weight, height, body mass index, number of prior laparotomies, operating times, operative blood loss, and types of operative procedure were similar for cases and controls. The length of the laparotomy incision in the minilaparotomy approach group was significantly shorter than that in the conventional approach group (median length 6.0 vs. 16.5 cm; p <0.05). Postoperative intervals until initial standing and walking were significantly shorter for minilaparotomy patients than conventional surgery patients (p <0.05 and p <0.05, respectively), whereas postoperative intervals until passing flatus, urinary catheter removal, and tolerance of liquids and solids did not differ for the two groups, nor did the analgesic requirement or postoperative hospital stay. Postoperative complications developed in two conventional-group patients; none was noted with the minilaparotomy approach. Our data suggest that the minilaparotomy approach to terminal ileal Crohn's disease without an enteric fistula is feasible, safe, and less invasive than the conventional approach.
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Affiliation(s)
- Tohru Nakagoe
- First Department of Surgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Lee SO, Jeong YJ. Colonoscopic clipping of fecal fistula that occurred as a postoperative complication in patients with perforated appendicitis: two case reports. Gastrointest Endosc 2001; 54:245-7. [PMID: 11474403 DOI: 10.1067/mge.2001.114411] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S O Lee
- Division of Gastroenterology of the Department of Internal Medicine and the Department of Surgery, Chonbuk National University Medical School, Chonju, Korea
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Abstract
Laparoscopy is still controversial when applied for the attempted cure of colorectal cancer. Although some advantages may be possible, some disadvantages also have been postulated. Laparoscopic treatment of benign disease is far less controversial. Three of the best procedures and indications, respectively, are laparoscopic sigmoid colectomy for diverticulitis, laparoscopic-assisted ileocolic resection for terminal ileal Crohn's disease, and laparoscopic stoma creation for perianal Crohn's disease. Other potentially advantageous surgeries and indications include laparoscopic-assisted total abdominal colectomy for colonic Crohn's disease, laparoscopic total proctocolectomy for colonic and anorectal Crohn's disease, and laparoscopic secondary ileoproctostomy or coloproctostomy as Hartmann reversal procedures. Significant benefits can be expected with these procedures relative to decreased pain; ileus; length of hospital stay; disability, and, possibly, adhesion formation and subsequent bowel obstruction, and improved cosmesis.
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Affiliation(s)
- S D Wexner
- Department of Surgery, Ohio State University Health Sciences Center, Cleveland Clinic Foundation, USA
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35
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Poulin EC, Schlachta CM, Mamazza J, Seshadri PA. Should enteric fistulas from Crohn's disease or diverticulitis be treated laparoscopically or by open surgery? A matched cohort study. Dis Colon Rectum 2000; 43:621-6; discussion 626-7. [PMID: 10826421 DOI: 10.1007/bf02235574] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to study a group of consecutive patients with enteric fistulas treated by laparoscopic surgery and to compare outcomes with a matched group of patients treated by open surgery. METHODS The outcomes of 13 patients with Crohn's disease or sigmoid diverticulitis with enteric fistulas treated laparoscopically (Group I) were compared with 13 patients matched for age, weight, gender, diagnosis, and characteristics of fistulas and treated by conventional surgery (Group II) during the same period. RESULTS No patient died postoperatively in either group. Mean operative time was 183 minutes in Group I vs. 154 minutes in Group II (P = 0.280). No significant difference was found between Groups I and II in the number of patients with major postoperative complications (3 vs. 5; P = 0.462), or postoperative stay (7.6 +/- 3.6 vs. 9.2 +/- 3 days; P = 0.239). Conversion to open laparotomy occurred in one (7.7 percent) patient from Group I. No patient required readmission for secondary surgery in Group I, and two patients were readmitted and underwent reoperation for complications in Group II (P = 0.462). CONCLUSIONS The laparoscopic treatment of selected cases of enteric fistulas is safe. Although most good outcome trends favor the laparoscopic group, the study is inconclusive, because no statistical difference was demonstrated with regard to operative time, number of postoperative complications, readmission rate, and length of postoperative stay, most likely because of the small number of cases in each arm of the study. Study of a greater number of cases outside the learning curve of the laparoscopic surgeons would clarify this issue. Other outcomes, including cost, pain control, cosmesis, and return to activities of daily living, need to be included in the evaluation.
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Affiliation(s)
- E C Poulin
- University of Toronto Centre for Minimally Invasive Surgery, St. Michael's Hospital, Ontario, Canada
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36
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Affiliation(s)
- B Salky
- Laparoscopic Surgery Center of New York, NY 10028, USA
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37
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Luan X, Gross E. Laparoscopic assisted surgery for Crohn's disease an initial experience and results. Curr Med Sci 2000; 20:332-5. [PMID: 12840928 DOI: 10.1007/bf02888196] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2000] [Indexed: 12/16/2022]
Abstract
The inflammatory process associated with Crohn's disease often makes dissection difficult, even in open surgery. The aim of this study was to assess the technical feasibility, safety and indication of laparoscopic assisted procedures performed in patients with Crohn's disease. Records of patients undergoing surgical operation for Crohn's disease from 1993 to 1998 at our hospital were reviewed. Intestinal resection was performed laparoscopically in 24 patients (LAP) and by open technique in 23 patients(OPEN). No significant differences existed as to age, gender, body-mass-index and previous surgery. In the laparoscopic group, seven operations (CON) were converted to open laparotomy (29%) because of large inflammatory mass and/or fistula. The mean intraoperative blood loss was significantly higher in CON- and OPEN-groups than in LAP-group (P < 0.01). Major complications occurred only in one patient who underwent laparoscopic assisted high anterior resection. Patients who underwent laparoscopic operation tolerated p.o. liquids sooner than patients who underwent open surgery (median: 2 vs. 5 day, P < 0.05). Compared with the CON- and OPEN-groups, patients in LAP-group had lower analgesic requirements (median: 3 vs. 6 and 5 day, P < 0.01). The median postoperative length of stay was significantly shorter in LAP-group than in OPEN-group (median: 11 vs. 14 day, P < 0.05). Our study showed that LAP is technically feasible for Crohn's disease. The preoperative correct diagnosis and selection of indications are very important, because the laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complex fistulas, or recurrent Crohn's disease.
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Affiliation(s)
- X Luan
- Department of Internal Medicine, Tongji Hospital, Tongji Medical University, Wuhan 430030
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Affiliation(s)
- Hultén
- Sahlgrenska University Hospital Institute for Surgical Science, Göteborg, Sweden, University Hospital of South Manchester, Manchester, UK University of Manchester, Manchester, UK
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40
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41
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Affiliation(s)
- R Bergamaschi
- National Centre for Advanced Laparoscopic Surgery, Trondheim University Hospital, Norway
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