Lending a hand: The utility of hand-assisted laparoscopic surgery in diverticulitis with fistula. Surgery 2024 Mar;175(3):776-781
Date
10/23/2023Pubmed ID
37867107DOI
10.1016/j.surg.2023.08.034Scopus ID
2-s2.0-85174461267 (requires institutional sign-in at Scopus site)Abstract
BACKGROUND: Current guidelines recommend elective colectomy for the management of diverticulitis-associated fistulas. These cases present considerable operative challenges, and surgical approaches and fistula tract management vary widely. Hand-assisted laparoscopic surgery offers the benefits of minimally invasive surgery while maintaining the tactile advantages of open surgery. This study aims to evaluate outcomes of hand-assisted laparoscopic surgery colectomy for diverticulitis-associated fistulas, fistula tract, and urinary catheter management.
METHODS: A retrospective review of patients with diverticulitis-associated fistula who underwent elective hand-assisted laparoscopic surgery colectomy between January 2, 2008, and September 8, 2022, was performed. Patients with Crohn disease or who underwent emergency surgery were excluded.
RESULTS: Seventy patients were included; the mean patient age was 64.1 ± 14.8 years, and the mean body mass index was 30.9 ± 9.1 kg/m2. Colovesical fistulas were most common (n = 48; 68.6%), followed by colovaginal fistulas (n = 22; 31.4%). The median operative time was 186 minutes. Conversion to an open approach occurred in 4 cases (5.7%). The fistula tract remnant was left without intervention in 35 patients (50%), and omental coverage occurred in 23 cases (32.9%). The median duration of the urinary catheter was 3 days (range = 1-63). There were no postoperative urine leaks. Three patients (4.3%) were readmitted in ≤30 days. There were no 30-day mortalities.
CONCLUSION: The challenges of colectomy for diverticulitis-associated fistulas can be mitigated using the hand-assisted laparoscopic surgery technique. We found a low conversion-to-open rate, falling below rates reported for laparoscopic colectomy. There were no cases of postoperative urine leak, suggesting that no intervention or omental coverage is a safe approach to fistula tract management.
Author List
Drezdzon MK, Calata JF, Peterson CY, Otterson MF, Ludwig KA, Ridolfi TJAuthors
Jed Calata MD Assistant Professor in the Surgery department at Medical College of WisconsinKirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Carrie Peterson MD, MS, FACS, FASCRS Associate Professor in the Surgery department at Medical College of Wisconsin
Timothy J. Ridolfi MD, MS, FACS Associate Professor in the Surgery department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedColectomy
Diverticulitis
Diverticulitis, Colonic
Hand-Assisted Laparoscopy
Humans
Intestinal Fistula
Laparoscopy
Middle Aged
Postoperative Complications
Retrospective Studies
Treatment Outcome