Krystle Lange, DO, Nicholas Rettenmaier, DO, Shankar Raman, MD. Mercy Medical Center
Introduction: Colonic fistula resulting from diverticular disease of the sigmoid colon is a technical challenge to be managed via minimally invasive approach. While laparoscopic surgery is considered to be the standard approach for sigmoid colectomy, its role in patients with complicated diverticular disease especially colonic fistula is not clear. We evaluated the results of laparoscopic colectomy in patients who had undergone computer tomography (CT) guided drainage of sigmoid diverticulitis and developed colonic fistula.
Methods: We conducted a retrospective study of all patients who underwent CT guided drainage of sigmoid diverticulitis with abscesses and subsequently developed fistula to the sigmoid colon from 2010-2015. Statistical analysis was performed using Stata 13.0. t-test, chi-squared test, Fisher’s exact test were performed where appropriate.
Results: There were 53 patients (25 males), age range 31-92 years, who underwent CT guided drainage followed by sigmoid colectomy. Median Body mass index of the cohort was 27.5 kg/m2 m (19.5-51.8). Mean size of the abscess was 6.13cm (3-18cm). Pericolic and pelvic were the most common location of the abscesses. 14/52 (26%) of patients needed repeat drainage prior to surgical intervention. 33 patients had colonic fistula (29 colocutaneous, 2 enterocolic,1 colovaginal , 1 colovesical). Four patients underwent emergent colon resection. Minimally invasive approach was successful in 38/40 patients [95% success rate]. Eight patients ended up with Hartmann’s procedure and loop ileostomy was performed in one patient. The minimally invasive approach had longer operating times when compared to the open approach [229.8± 60.5 versus 216.3± 115.0 minutes, p= 0.69]. There was no significant difference in the operating time between patients with colonic fistula versus those without [224.3± 88.7 versus 230.2± 55.01 minutes, p= 0.76]. Laparoscopic approach was associated with significantly shorter length of stay when compared to the open approach [3.6± 2.6 versus 13.1± 11.1 days, p= 0.01]. There were seven readmissions [7/53 = 13.2%]. 15 patients had complications within 30 days [15/53= 28.30%]. There was no mortality. There were no differences in readmissions or 30 day complications between patients with a colonic fistula and those without.
Conclusion: Patients with colonic fistula following CT guided drainage of diverticular abscesses can be safely treated with laparoscopic colon resection without significant increase in OR time but with significantly shorter length of stay.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79819
Program Number: S045
Presentation Session: Colorectal 1
Presentation Type: Podium