Complicated Diverticulitis. Laparoscopic Therapy of Sigmoidovaginal Fistula

Background: In 10-20% sigmoid diverticulitis takes a complicated course requiring surgery. Indications are perforation, abscess, bleeding and fistula formation, the last rarely presenting as sigmoidovaginal fistula. Methods: Successfully applied to various colonic diseases, the value of laparoscopy in complicated diverticulitis is controversial. However, it has shown to be a safe and effective method. Reviewing the relevant literature, the authors present an own concept for the laparoscopic treatment of sigmoidovaginal fistulas in complicated diverticulitis. Therefore, an intraabdominal suture of the vagina and omentoplasty is added to routine sigmoid resection and primary anastomosis. Results: In three cases surgery was performed laparoscopically with a mean operation time of 243 minutes. Postoperative morbiditiy (1 major complication, 1 minor complication) and mortality were comparable to the literature. Patients were discharged from the hospital after 13 days (median) for normal food tolerance (fluid: 1,7 days, solid: 6,3 days) and bowel movement. No recurrence of fistula was observed during the 30-day follow-up. Conclusion: Results give further support to the value of laparoscopy as the standard therapy for complicated diverticulitis in the authors' clinic.