V2-08: Rectovesical Fistula: Robot Assisted Laparoscopic Management
VideoIntroductions and Objectives
Management of postoperative rectovesical fistulas following prostatectomy can be a challenge for the practicing surgeon. There have been numerous approaches suggested in the past, but all have high morbidity, extended convalescence, and recurrence can be common. Here we present a 68 year old male who had undergone a laparoscopic prostatectomy. He then developed a rectovesical fistula and large diverticulum, most likely from a posterior disruption of his anastomosis. He underwent several failed attempts at repair including a colonic diversion prior to being displaced by Hurricane Katrina and lost to follow up. He presented 9 years later for definitive treatment. Our objective is to demonstrate a novel and interesting use of robotic and minimally invasive techniques to minimize morbidity and decrease the risk of recurrence.
After placement of ureteral catheters and a guide-wire through the patients fistula; a robot assisted laparoscopic transvescial excision of the patient’s rectovesical fistula and bladder diverticulectomy was performed. This was done similarly to how one would perform a robot assisted laparoscopic simple prostatectomy providing excellent visualization of the diverticulum and fistula. Once excised, the fistula was closed in multiple layers. The mucosal lining of the diverticulum was then excised and the detrusor muscle was closed. The mucosa and detrusor were then closed; re-approximating the bladder neck into a normal anatomical position.
This patient has had no recurrence of his fistula, is continent, and scheduled for colostomy reversal.
With a creative mind, minimally invasive techniques can be utilized to treat these devastating complications successfully.