eP657 - Diverticular Colovaginal and Colovesical Fistulas Can Be Successfully Managed with a Robotic Approach: A Single Center Experience

Purpose/Background: Colovesical and colovaginal fistula formation is an uncommon complication of diverticular disease that often requires surgical intervention. The published rates of conversion to open for elective robotic sigmoidectomy for diverticulitis without fistulas present is 8.3%. There is limited publication of rates for robotic management of fistulas. However; laparoscopic rates of conversion to open are reported to be in 20-40% of cases. The aim of this study is to report our single-center outcomes of robotic management of diverticular fistulas with our primary outcome being the rate of conversion to open.Methods/Interventions: All cases of robotic sigmoid resections for diverticular colovaginal and colovesical fistulas performed from 1/1/2018 to 8/1/2023 by a single board-certified colorectal surgeon were included. Patient demographic variables including age, sex, body mass index (BMI), ASA class, Charlson comorbidity index (CCI), and history of prior pelvic surgery were retrospectively collected. Intraoperative variables recorded were conversion to open rate, estimated blood loss (EBL), operative time (OT), ostomy creation, intraoperative complications, repair approach to bladder or vagina (primary repair or omental pedicle flap). Thirty day outcomes recorded were hospital length of stay (LOS), post operative complications including ileus, urinary tract infection (UTI), and anastomotic leak/abscess, re-admission rates.Results/Outcomes: Thirty-five patients were included, 21 with colovesical and 14 with colovaginal fistulas. The demographic information for both groups was similar, represented in table 1. Eleven of the 21 colovesical patients and all 14 of the colovaginal patients had prior pelvic surgery. The combined rate of conversion to open was 8.6%. When separated by fistula type, colovesical fistula take down conversion rate was 14.3% (3 out of 21). None of the colovaginal fistula patients were converted to open. Reasons for conversion to open were extensive fibrotic scar tissue, and difficulty identifying the ureter. Secondary outcomes demonstrated similar OT and EBL. There was one intraoperative complication, which was a ureter injury during a colovesical fistula case. For both groups, rates of primary repair of the fistula site and creation of an omental pedicle flap were similar. Two patients required ostomy creation, both in the colovaginal group. One ostomy was a diverting loop ileostomy, the second was an end colostomy. Thirty day outcomes showed three patients in the colovesical group developed an ileus compared to one in the colovaginal group. There were two UTIs, both in the colovesical group. Thirty-day readmission and LOS for both groups were similar.Conclusion/

Discussion: This data demonstrates that benign diverticular fistulas can be managed successfully with the robotic approach. Conversions are more likely to occur in patients with colovesical fistulas, with the primary reason for conversion to open being difficulty dissecting fibrotic tissue. Overall, these operations can be achieved successfully with minimal morbidity or complications utilizing the robotic platform with appropriate surgeon experience."Table 1. Patient demographics

Patient demographics including average age, body mass index (BMI), ASA class (ASA), Charlson Comorbidity Index (CCI), and percent with prior pelvic surgery.
Table 2. Peri-operative and post-operative outcomes

Demonstrates conversion to open rates, average operative time (OT) from incision to closure, average estimated blood loss (EBL), percent of complications during surgery, percent of patients who received primary fistula repairs and omental pedicle flap creation. Post operative outcomes reported are length of stay (LOS), rates of ileus and urinary tract infection (UTI), re-admission within 30 days and rates of abscess/anastomotic leaks."