Laparoscopic urorectal fistula repair: value of the salvage prostatectomy and review of current approaches

ABSTRACT

The surgical approach and repair for urorectal fistulas [URF] is a challenging task A variety of techniques have been described to treat URFs and the laparoscopic approach has approved as an efficient tool for even some complex fistulas. We aimed to report our laparoscopic experience for complex URF repair with special emphasis on salvage prostatectomy. The study included four men [59-75 years], with laparoscopic repair for complex URFs; URF developed after TUR-P in patient 2 and 3 and after radical prostatectomy in patient 4. Patient 1 had received combined radiotherapy and chemotherapy for the rectum carcinoma and developed thereafter a prostatic abscess which resulted at the end to URF, Laparoscopic salvage prostatectomy was performed for patient 1 and 2. Transvesical laparoscopic approach was performed for patient 3 and transperitoneal transvesical technique was performed for patient 4. A tunica vaginalis flap was used for patient 1 and a peritoneal interposition flaps were developed in patients 2 and 4. The range of operative time was 114-283 min. Blood loss was 50-600 cc. and no patients needed intraoperative blood transfusion. Post-operative hospital stay was 12-34 days. The urethral catheter was removed on postoperative day 11-32 and the cystographies showed no leakage of contrast except in patient 1. Laparoscopic URF repair is safe and efficacious in experienced hands even in complex cases and salvage laparoscopic prostatectomy seems like a valuable operative option, However the technique requires advanced experience, particularly with pelvic surgery and intracorporeal suturing