Laparoscopic resection of diverticular fistulae: a 10-year experience.

Objective  Until recently the laparoscopic approach was reserved for uncomplicated diverticular disease. We show that fistulating diverticular disease can be resected safely, with good clinical outcome via a laparoscopic approach. Method  Between April 1994 and May 2005, 31 consecutive patients [17 male, median age of 63 years (range 40–85)], underwent attempted laparoscopic resection for diverticular fistulae. Patient data were prospectively recorded. Results  There were 22 colovesical and nine colovaginal fistulae. The median operative time was 150 min (range 60–310) and the median postoperative stay was 7 days (range 3–21). Conversion to an open procedure was required in nine of 31 patients (29%). This rate fell to 10% in cases performed after April 2000. There were two nonsurgically related postoperative deaths. Both occurred in the converted group. At 3 months follow-up, two patients complained of frequency of stools, which settled by 6 months. To date there has been no recurrence of symptomatic diverticulosis or fistulation. Conclusion  Totally laparoscopic resection for diverticular fistulae is safe and feasible. Fistulae should not be considered as a contraindication to laparoscopic resection for an experienced laparoscopic surgeon.