SIGMOID-URINARY BLADDER AND SIGMOID-VAGINAL FISTULAS POST-ACUTE DIVERTICULITIS. SURGICAL TREATMENT WITH ROBOTIC PLATFORM AND MULTIDISCIPLINARY TEAM

Introduction The most frequent fistula after acute diverticulitis is the colon-vesical fistula, followed by the colon-vaginal fistula. Surgical treatment is challenging due to the pelvic blockage, the inflammatory process involving important structures such as the ureters, pelvic vessels, bladder, and vagina. A multidisciplinary team is crucial for the management and surgical treatment of these fistulas. The robotic platform, with its high-definition 3D imaging, articulated instruments, and the use of fluorescence, provides greater safety and facilitates the surgical procedure.

Objective To demonstrate through a video the surgical treatment of a patient with colon-vesical and colon-vaginal fistulas post-acute diverticulitis, using the robotic platform and a multidisciplinary team.

Method A 58-year-old female patient with a history of recurrent acute diverticulitis crises followed by air leakage through the urethra and vagina, and a previous hysterectomy. A cystoscopy was performed, revealing a fistulous opening to the bladder. The ureters were catheterized, and indocyanine green was infused to identify the ureters during surgery using Firefly fluorescence. The first difficulty was the release of adhesions due to the recurrent acute diverticulitis crises and prior hysterectomy. After identifying the fistula with the bladder, the urologist opted to open the bladder to better dissect and avoid injury to the ureteral orifices. The gynecologist performed the dissection of the vaginal vault, injecting indocyanine green into the vagina and using Firefly to identify the fistulous tract. The colorectal surgeon performed a rectosigmoidectomy, with the specimen removed through a suprapubic incision, and the loop was prepared for anastomosis.

Result The patient progressed well postoperatively with minimal pain and early ambulation. Discharged on the 5th postoperative day with a urinary catheter in place.

Conclusion The robotic platform has demonstrated a significant contribution to achieving good results in cases of these complex fistulas. The use of fluorescence for identifying the ureters and perfusing the anastomoses provides greater safety for the surgeon, resulting in successful surgeries. Additionally, the involvement of a multidisciplinary team in managing pelvic structures ensures a safer surgery and better outcomes.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025