Diverticular disease complicated with colovesical fistula: laparoscopic versus robotic management.

Abstract

Fistula formation is a complication of diverticulitis in 4% to 20% of cases. The left or sigmoid colon is the most commonly involved segment. The most common presenting symptom is pneumaturia and dysuria, followed by fecaluria, abdominal pain and, rarely, hematuria. Some colovesical fistulas (CVFs) are asymptomatic. CVF is more common in males and in females with a history of hysterectomy. The diagnosis is usually made clinically but can be confirmed by cystoscopy, sigmoidoscopy, barium enema, computed tomography (CT) scan, magnetic resonance imaging (MRI), or virtual colonoscopy. The usual management for symptomatic patients is colon resection, and there is still controversy in the approach to asymptomatic patients. Left colectomy for CVF secondary to diverticular disease can be very challenging owing to the presence of acute and chronic inflammation, which makes the tissues harder and more prone to bleeding. It is also more difficult to visualize and find proper anatomic planes and to identify vital structures. Conversion rates of laparoscopic sigmoidectomy complicated with diverticulitis are double that for cancer and as high as 30%. In general, a colectomy for diverticulitis is considered a more difficult operation than a colectomy for cancer, whether or not a laparoscopic or open approach is chosen. Some authors have proposed laparoscopic surgery as the gold standard approach for diverticular disease and CVF management. The safety of robotic surgery for colorectal diseases has been previously addressed in other studies. The