Minimally Invasive Management of Post-treatment Rectovesical Fistulae.

Journal: Journal of endourology
PMID: 36150030

Abstract

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

Authors

  • Luis G Medina
    USC Institute of Urology, University of Southern California, 1441 Eastlake Ave., Suite 7416, Los Angeles, CA, 90089-9178, USA.
  • Anibal La Riva
    USC Institute of Urology, University of Southern California, Los Angeles, California, USA.
  • Laura C Perez
    Catherine and Joseph Aresty Department of Urology, Center for Robotic Simulation and Education, USC Institute of Urology, University of Southern California, Los Angeles, California, USA.
  • Aref S Sayegh
    USC Institute of Urology, University of Southern California, Los Angeles, California, USA.
  • David G Ortega
    USC Institute of Urology, University of Southern California, Los Angeles, California, USA.
  • Enanyeli Rangel
    USC Institute of Urology, University of Southern California, Los Angeles, California, USA.
  • Angelica B Hernandez
    Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
  • Maria A Lizana
    USC Institute of Urology, University of Southern California, Los Angeles, California, USA.
  • Hernan A Aponte
    Fundación Universitaria Ciencias de la Salud, Hospital de San José, Bogotá, Colombia.
  • Alexis Sanchez
    Corporate Director Robotic Surgery Program, Orlando Health, Orlando, FL, USA.
  • Charles F Polotti
    USC, Institute of Urology, University of Southern California, Los Angeles, California, USA.
  • Giovanni E Cacciamani
    USC Institute of Urology, Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA - giovanni.cacciamani@med.usc.edu.
  • Rene Sotelo
    USC Institute of Urology, University of Southern California, 1441 Eastlake Ave., Suite 7416, Los Angeles, CA, 90089-9178, USA. Rene.Sotelo@med.usc.edu.

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