Minimally Invasive Management of Post-Treatment Rectovesical Fistulae.

Abstract

To report our experience in minimally invasive management of rectovesical fistulae (RVF). Between 2004 and 2021, 24 patients who underwent minimally invasive RVF repair by a single surgeon at three international institutions were retrospectively reviewed. Baseline demographic characteristics, perioperative, and postoperative variables were collected. Complications were reported using the modified Clavien-Dindo Classification System and the European Association of Urology Complication Panel Assesment and Recommendations. Fistulae repair success was defined as confirmation of fistula closure by imaging and complete resolution of fistula-related symptoms at 12-month of follow-up. Continuous variables were reported as median and quartiles, whereas categorical variables were reported as frequencies and percentages. Twenty four patients with RVF were treated: 22 male (91.7%) and 2 female with a median age of 66 (64.2-68) years. Twenty cases (83.3%) occurred post-surgery, three cases (12.5%) after surgery with combined radiotherapy and one case (4.1%) arose after a combination of energy treatments. A robotic approach was performed in 19 patients (79%) and laparoscopic approach was used in 5 patients (21%). 96% of the patients had previous fecal diversions. No intraoperative complications were recorded. Median operative time (OT) was 180 (140-282) min, estimated blood loss (EBL) was 50 (40-125) mL, and length of hospital stay (LOS) was 2 (2-3) days. There were two grade II and one grade IIIb complications. All patients met criteria for successful repair. Minimally invasive management of RVF is feasible. More studies are needed to assess the role of this approach within all RVF management options.