Advantages of Minimally Invasive Surgery for the Treatment of Colovesical Fistula.

BACKGROUND: Colovesical fistulas in two-thirds of the cases are due to diverticular disease. In recent years, a minimally invasive approach has shown advantages over the traditional open approach. The goal of this study was to evaluate the surgical results and safety of the laparoscopic procedure in patients with colovesical fistula.

MATERIAL AND METHODS: We retrospectively evaluated 24 patients who underwent surgery for colovesical fistula in a referral center from 2005 to 2011. Patients were divided into two groups: (i) laparoscopic approach, and (ii) open approach.

RESULTS: The laparoscopic and open groups had similar characteristics with respect to age and gender distribution. There were a higher number of bladder repairs in the open approach group (83.3 vs. 16.6%; p = 0.01). The operative time (212 ± 74 min vs. 243 ± 69 min; p = 0.313) and intraoperative bleeding (268 ± 222 ml vs. 327 ± 169 ml; p = 0.465) were similar in both groups. The conversion rate of the laparoscopic approach to open surgery was 25%. There was no difference in morbidity (41.1 vs. 25%; p = 0.414), although the laparoscopic group had a shorter hospital stay (9 ± 4 days vs. 15 ± 11 days; p = 0.083) without statistical significance.

CONCLUSIONS: The treatment of colovesical fistula by a laparoscopic approach is safe and is associated with less bladder repairs and a shorter hospital stay.