Abstract
BACKGROUND: Diverticular disease is the leading cause of colovaginal fistulas. Surgery is challenging given the inflammatory process that makes dissection difficult. To date, studies are small and include fistula secondary to multiple etiologies. OBJECTIVE: The objectives of this study were to examine surgical outcomes of diverticular colovaginal fistulas and to identify variables associated with successful closure. DESIGN: This was a retrospective study of a prospectively maintained clinical database. SETTINGS: The study was conducted at a single tertiary referral center. PATIENTS: Women with diverticular colovaginal fistulas, who underwent surgical repair with intent to close the fistula, were included. INTERVENTIONS: Repair of colovaginal fistula through minimally invasive or open techniques was involved. MAIN OUTCOME MEASURES: Successful closure of fistula, defined as resolution of symptoms and no stoma, was measured. RESULTS: Fifty-two patients underwent surgical treatment of diverticular colovaginal fistula, 23 (44%) of whom underwent a minimally invasive approach (conversion rate of 22%). Ostomy construction and omental pedicle flaps were used in 28 (54%) and 38 patients (73%). Surgery was successful in 47 patients (90%). Accounting for secondary operations, ultimate success and failure rates were 49 (94.0%) and 3 (5.7%). There was no difference in postoperative morbidity between the 2 groups (5 patients with Clavien-Dindo III/IV complications in the success group versus 2 patients in the failure group; 10.6% vs 40.0%; p = 0.44). Failure to achieve fistula closure was not associated with perioperative variables, age, BMI, diabetes mellitus, ASA grade, steroid use, previous abdominal surgery or hysterectomy, use of omentoplasty, or ostomy. Patients who failed were more likely to be smokers (60.0% vs 12.8%; p = 0.03). LIMITATIONS: Limitations include the retrospective design and lack of power. CONCLUSIONS: Surgery is effective in achieving successful closure of diverticular colovaginal fistula. Smokers should be encouraged to stop before embarking on an elective repair. Although the use of fecal diversion and omental pedicle flaps did not correlate with success, they should be used when clinically appropriate