title: Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review.
abstract: BACKGROUND
  Laparoscopic surgery is considered in the treatment of diverticular fistula for the possible reduction of overall morbidity and complication rate if compared to open surgery. Aim of this review is to assess the possible advantages deriving from a laparoscopic approach in the treatment of diverticular fistulas of the colon.
  
  
  METHODS
  Studies presenting at least 10 adult patients who underwent laparoscopic surgery for sigmoid diverticular fistula were reviewed. Fistula recurrence, reintervention, Hartmann's procedure or proximal diversion, conversion to laparotomy were the outcomes considered.
  
  
  RESULTS
  11 non randomized studies were included. Rates of fistula recurrence (0.8%), early reintervention (30 days) (2%) and need for Hartmann's procedure or proximal diversion (1.4%) did not show significant difference between laparoscopy and open technique.
  
  
  CONCLUSIONS
  there is still concern about which surgery in complicated diverticulitis should be preferred. Laparoscopic approach has led to less postoperative pain, shorter hospital stay, faster recovery and better cosmetic results. Laparoscopic resection and primary anastomosis is a possible approach to sigmoid fistulas but its advantages in terms of lower mortality rate and postoperative stay after colon resection with primary anastomosis should be interpreted with caution. When there is firm evidence supporting it, it is likely that minimally invasive surgery should become the standard approach for diverticular fistulas, thus achieving adequate exposure and better visualization of the surgical field.
  
  
  CONCLUSIONS
  The lack of RCTs, the small sample size, the heterogeneity of literature do not allow to draw statistically significant conclusions on the laparoscopic surgery for fistulas despite this approach is considered safe.
authors.affiliation: Department of Digestive Surgery and Liver Unit, University of Perugai, St Maria Hospital, Viale Tristano di Joannuccio, 1, 05100 Terni, Italy. Electronic address: cirocchiroberto@yahoo.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cirocchi
authors.affiliation: Department of Surgical Sciences, University of Turin, C.So Dogliotti, 38, 10126 Torino, Italy. Electronic address: alberto.arezzo@unito.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Arezzo
authors.affiliation: Department of General and Oncologic Surgery, University of Perugia, S. Andrea delle Fratte, Piazzale Menghini, 1, 06157 Perugia, Italy. Electronic address: renzicla@virgilio.it.
authors.forename: Claudio
authors.initials: C
authors.lastname: Renzi
authors.affiliation: Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Viale Tristano di Joannuccio, 1, 05100 Terni, Italy. Electronic address: giovannicochetti@libero.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cochetti
authors.affiliation: Department of Surgical Sciences, 'Sapienza' University of Rome, Viale Regina Elena 324, 00185 Rome, Italy. Electronic address: vito.dandrea@uniroma1.it.
authors.forename: Vito
authors.initials: V
authors.lastname: D'Andrea
authors.affiliation: Section for Surgical Research (Prof Uranues), Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria. Electronic address: abefingerhut@aol.com.
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
authors.affiliation: Department of Surgical and Biomedical Science, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, University of Perugia, Viale Tristano di Joannuccio, 1, 05100 Terni, Italy. Electronic address: ettore.mearini@unipg.it.
authors.forename: Ettore
authors.initials: E
authors.lastname: Mearini
authors.affiliation: Department of General Surgery, Galliera Hospital, Mura Delle Cappuccine, 14, 16128 Genoa, Italy. Electronic address: gian.andrea.binda@galliera.it.
authors.forename: Gian Andrea
authors.initials: GA
authors.lastname: Binda
mesh_terms: D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid; D004239:Diverticulitis, Colonic / Q000150:complications*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*
keywords: Bladder; Colon; Diverticular fistula; Diverticulitis; Laparoscopic surgery