Laparoscopic Repair of Colo-Ovarian Fistula

Abstract

<h3>Study Objective</h3> To demonstrate a unique laparoscopic approach to repair of a colo-ovarian fistula causing recurrent tubo-ovarian abscess. <h3>Design</h3> A step-by-step surgical video highlighting relevant anatomy and describing key steps to repair of colo-ovarian fistula laparoscopically. <h3>Setting</h3> Tertiary care academic teaching hospital. <h3>Patients or Participants</h3> 51-year-old gravida 0 patient with a recurrent tubo-ovarian abscess found to be caused by a colo-ovarian fistula. <h3>Interventions</h3> After failing trial of medical management with antibiotics and interventional radiology-guided drainage of a tubo-ovarian abscess, the patient was taken to surgery for a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy. During the surgery, the patient was found to have a colo-ovarian fistula, which was the cause of recurrent abscess. The patient underwent a successful laparoscopic repair of the colo-ovarian fistula by excision of the fistulous tract and repair of bowel in two layers. <h3>Measurements and Main Results</h3> The laparoscopic repair of a colo-ovarian fistula was completed without complication. The pathology confirmed findings of a fistulous tract. At post-operative follow-up in both one month and two years, the patient was doing well without concerns. <h3>Conclusion</h3> In this video, we propose a novel approach to repair of a colo-ovarian fistula laparoscopically. Although en-bloc resection has been described for repair of colo-ovarian fistula, in this patient without active inflammation, dissection of the fistulous tract could be achieved after control of blood supply and careful interrogation of surgical planes. The defect was then repaired using a two-layered closure. This approach can be applied in appropriately selected patients to offer repair in a minimally invasive fashion.