title: Colovesical Fistula Complicating Diverticular Disease: A 14-Year Experience.
abstract: OBJECTIVE
  Colovesical fistulas (CVF) constitute the most common type of spontaneously occurring fistulas associated with diverticular disease. One-stage laparoscopic resection has been shown to be feasible, but studies comparing this approach to open surgery are scarce. The aim of this study was to compare the clinical outcomes of open and laparoscopic surgery for CVF of diverticular origin.
  
  
  METHODS
  From January 2000 to July 2014, 37 colectomies were performed for diverticular disease-related CVF. Twenty-eight patients who underwent resection and primary anastomosis were divided in 2 groups: the laparoscopic surgery group (group A) and the open surgery group (group B). We have analyzed the following parameters: operative time, complication rate, hospital stay, recurrence, and early mortality rate.
  
  
  RESULTS
  Groups A and B were comparable in terms of age, sex, diverticulitis episodes, previous abdominal surgery, and body mass index.The mean duration of surgery was significantly shorter in group B: 175 versus 237 minutes (P=0.011). There was a faster recovery of gastrointestinal transit in group A (2 vs. 13; P=0, 0002). However, there were no significant differences between the groups with respect to serious postoperative morbidity [(Clavien-Dindo scores of 3, 4, and 5) 4 vs. 0; P=0.098)] and with respect to hospital stay (10.5 vs. 9.5 d; P=0.537). There was no recurrence during a median follow-up of 12 months.
  
  
  CONCLUSIONS
  Laparoscopic resection and primary anastomosis should be considered a safe and feasible option for the management of diverticular CVF. Despite progresses in minimally invasive colorectal surgery, the conversion rate and morbidity are still high.
authors.affiliation: *Department of General and Digestive Surgery, La Cavale Blanche University Hospital, Brest †Department of Digestive and Endocrine Surgery, Clinique de Chirurgie Digestive et Endocrinienne, University Hospital of Nantes, Hôtel Dieu, Nantes, France.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Badic
authors.forename: Geoffroy
authors.initials: G
authors.lastname: Leroux
authors.forename: Jérémie
authors.initials: J
authors.lastname: Thereaux
authors.forename: Aurélien
authors.initials: A
authors.lastname: Joumond
authors.forename: Charles H
authors.initials: CH
authors.lastname: Gancel
authors.forename: Jean P
authors.initials: JP
authors.lastname: Bail
authors.forename: Guillaume
authors.initials: G
authors.lastname: Meurette
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods; D004241:Diverticulum, Colon / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D012008:Recurrence; D016896:Treatment Outcome