title: Single-incision laparoscopic (SIL) sigmoid colectomy and uterus-preserving repair for colo-uterine fistula secondary to severe diverticular disease: an unusual technical solution for an unusual presentation of a common disease.
abstract: Colouterine fistula as a potential complication of chronic diverticulitis is a rare entity with less than 30 cases reported worldwide. Generally, patients require a multidisciplinary approach including a major laparotomy with hysterectomy and sigmoid colectomy, and, occasionally, temporary colostomy. We report the first attempt of a novel, minimally invasive technique for managing a case of benign colouterine fistula with single-incision laparoscopic (SIL) sigmoid colectomy and uterus preservation. A small, 3 cm incision site provided access for the whole operation, as well as played a role as the specimen extraction site. Malignant fistulas and large uterine defects may require hysterectomy, however, laparoscopic closure of uterine wall defects can be considered as a reasonable alternative in selected patients, avoiding the higher risks associated with hysterectomy and keeping fertility at younger ages. Single incision laparoscopy in complicated diverticular disease and fistula formation cases is a challenging but technically feasible option, in experienced hands.
authors.affiliation: Department of Surgery, St Borbala Hospital, Tatabanya, Hungary.
authors.forename: Balazs
authors.initials: B
authors.lastname: Banky
authors.affiliation: Department of Colorectal Surgery, University Hospital North Tees, Stockton on Tees, UK.
authors.forename: Fergal
authors.initials: F
authors.lastname: Marlborough
authors.affiliation: Department of Colorectal Surgery, University Hospital North Tees, Stockton on Tees, UK.
authors.forename: Iona
authors.initials: I
authors.lastname: MacLeod
authors.affiliation: Department of Colorectal Surgery, University Hospital North Tees, Stockton on Tees, UK.
authors.forename: Talvinder S
authors.initials: TS
authors.lastname: Gill
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods*; D012809:Colon, Sigmoid / Q000601:surgery; D003108:Colonic Diseases / Q000209:etiology / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000150:complications*; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D011183:Postoperative Complications / Q000601:surgery; D014591:Uterine Diseases / Q000209:etiology / Q000601:surgery*; D014599:Uterus / Q000601:surgery