EP225 - Robotic-assisted Management of Colovesical and Colovaginal Fistula in Complicated Diverticulitis: A Retrospective, Single Institution Experience

Sunday, May 11, 2025

9:27 AM – 9:32 AM PT

Location: Monitor 2, Sails Pavilion, Upper Level

ePoster Presenter(s)

Michael H. Froehlich, MD (he/him/his)

General Surgery Resident
Stony Brook University Hospital
Stony Brook University Hospital
Stony Brook, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

DR

David Roberts, DO

General Surgery Resident
Stony Brook University Hospital
Hauppauge, New York, United States

Disclosure information not submitted.
IV

Isabelle Van Roy, MD

Surgery Resident
Stony Brook Medicine
Manhasset, New York, United States

Disclosure information not submitted.
CM

Christopher M. Mazis, MD

General Surgery Resident
Stony Brook University Hospital
Yaphank, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
SY

Suresh B. Yelika, MD

Assistant Professor of Surgery
Stony Brook University
Selden, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Mark Heimberger, MD

Colorectal Surgery Fellow
Stony Brook University
Oakdale, NY, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
PD

Paula I. Denoya, MD

Clinical Associate Professor of Surgery
Renaissance School of Medicine at Stony Brook University
Stony Brook, New York, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
NA

Nicholas J. Ahn, MD

Assistant professor
Stony Brook University Hospital
Port Jefferson, New York, United States

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This individual has no financial relationships with ineligible companies.

Senior Author(s)

DN

Deborah Nagle, MD

Chief, Division of Colon and Rectal Surgery
Stony Brook University Hospital
Stony Brook, New York, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Michael H. Froehlich, MD: This individual has no financial relationships with ineligible companies.

Christopher M. Mazis, MD: This individual has no financial relationships with ineligible companies.

Suresh B. Yelika, MD: This individual has no financial relationships with ineligible companies.

Mark Heimberger, MD: This individual has no financial relationships with ineligible companies.

Paula I. Denoya, MD: This individual has no financial relationships with ineligible companies.

Nicholas J. Ahn, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Colovesical (CVeF) and colovaginal (CVaF) fistulas are rare complications of diverticular disease that often present operative challenges and nuanced post-operative management strategies. We present our series of robotic-assisted sigmoid colectomy and CVeF or CVaF takedowns.

Methods/Interventions: This is a single institution case series of patients who underwent robotic sigmoid colectomy and concurrent CVeF or CVaF takedown and repair from January 2020 to June 2024. Demographics, pre-, intra-, and post-operative data were analyzed. Independent-sample T tests, Chi-squared, ANOVA, Mann Whitney tests, as well as Linear Regression were used to analyze data.

Results/Outcomes: 28 patients met inclusion criteria, 19 with CVeF and 9 with CVaF. Mean age was 68.2 years; 92.9% were Caucasian. Underlying comorbidities included DMII (3.6%), CKD (10.7%), COPD (17.9%), and CHF (7.1%). 17.9% were current smokers and 46.4% former smokers. More than two-thirds (67.9%) had previous unrelated abdominal surgery, open or minimally invasive. The majority of patients (89.3%) were ASA Class 3 and functionally independent.

Intra-operative Urology consultation was requested in 3 CVeF cases (15.8%) and Gynecology consultation in 3 cases for CVaF (33.3%). There was only 1 ureteral injury (3.6%). Pre-operative ureteral ICG instillation was performed in 67.9% of cases. No ureteral injuries occurred in this group. 2 cases required intra-operative ureteral stenting and ICG instillation. Intra-operative bladder distention was performed in 84.2% of CVeF cases, with 1 (5.3%) positive for leak. Post-operative CT cystogram was performed in 2/19 (10.5%) patients, with 1 positive in the patient with known intra-operative bladder leak. Mean urinary catheter duration was 3.6 days in patients who did not undergo CT cystogram compared to 10 days in those who did (p=0.012).

5 patients (17.9%) received diverting loop ileostomy after colorectal anastomosis, all of which have subsequently been reversed. 4 cases (14.3%) were converted to open and 1 case (3.6%) was aborted, with the patient receiving an end colostomy. There was 1 case (3.6%) of anastomotic leak requiring return to the operating room. Post-operative intra-abdominal infection rate was 10.7% (3/28 patients).

Mean robotic console time was 174 minutes; 173 minutes in CVeF cases and 177 minutes in CVaF cases. There was no statistical increase or decrease in console time for CVeF (p=0.676) or CVaF cases (p=0.119) over the 4.5 year study period, reflecting the inherent difficulty of these cases (Figure 1). Mean length of stay was 5.0 days. Readmission rate was 14.3% within 90 days. There was no significant difference between CVeF and CVaF cases in these outcomes.

Conclusion/Discussion: Robotic-assisted sigmoidectomy for management of CVeF and CVaF secondary to diverticulitis is a safe and feasible option with low rates of complications. ICG aids in ureteral identification and preservation during dissection in a chronically inflamed operative field. There is a paucity of evidence for optimal duration of post-operative indwelling urinary catheter in CVeF cases, with some suggesting safe removal prior to post-operative day 7. Our series of 3.5 days without an increase in urinary complications adds to evidence that early catheter removal after CVeF repair is safe. CT cystogram should be reserved for patients with positive intra-operative leak tests or those with strong suspicion for ongoing leak. The sample size is the main limitation of our study. Future investigations may benefit from multicenter review.