Surgical outcomes of laparoscopic sigmoidectomy in patients with diverticular colovesical fistula

Abstract Introduction: Colovesical fistula (CVF) is the most common diverticular fistula. We aimed to determine the safety and feasibility of laparoscopic sigmoidectomy (LS) in patients with CVF. Patients and Methods: We performed a retrospective analysis of a prospectively collected database of patients undergoing elective LS for diverticular disease between 2010 and 2023. The sample was divided into two groups: patients with diverticular CVF (CVF group) and patients with recurrent diverticulitis (No-CVF group). Demographics, operative and post-operative variables were analysed and compared between groups. A propensity score matching (2:1) with a control population undergoing elective colorectal resection for recurrent diverticulitis was performed. A cumulative sum analysis was also performed to determine the learning curve for LS in patients with CVF. Results: After propensity score matching, a total of 123 patients were included; 42 patients belonged to the CVF group and 81 to the No-CVF group. No significant differences were found regarding mean operative time, conversion rate, anastomotic leakage rate, overall post-operative morbidity, length of hospital stay, major morbidity and/or mortality. For patients with CVF, a significant decrease in operative time was observed after 13 procedures. Conclusion: LS is feasible and safe for patients with diverticular CVF and has similar morbidity and mortality rates as LS for patients with recurrent diverticulitis. Minimally invasive surgery should be advocated for patients with diverticular CVF in centres with vast experience in laparoscopic colorectal surgery.