Treatment of rectoanastomotic fistulae after laparoscopic radical prostatectomy

Česká verzia

Authors: Květoslav Novák ¹; Radim Kočvara ¹; Tomáš Hanuš ¹; Petr Macek ¹; Oldřich Paul ²; David Michalský ²
Authors place of work: Urologická klinika VFN a 1. LF UK, Praha ¹; 1. chirurgická klinika VFN a 1. LF UK, Praha ²
Published in the journal: Ces Urol 2019; 23(2): 124-130
Category: Original Articles

Summary

Aim: Rectoanastomotic fistula after laparoscopic radical prostatectomy (LRP) is an infrequent but serious complication. A bowel diversion above the fistula (sigmoidostomy) is needed just like urinary diversion (permanent urethral catheter and epicystostomy 15CH). This is the only chance for spontaneous closure of the fistula but surgical occlusion is more frequent.

Material a methods: From 2008 to 2018 we diagnosed rectoanastomotic fistula in 5 patients from 688 after LRP (0,72 %). Fistula appeared from the 6th to 14th day postoperatively. Diagnosis was confirmed either with cystography or urethrocystography. Immediate both urinary diversions with permanent catheter and epicystostomy (15CH) were inserted and sigmoidostomy was performed as soon as possible (day 1–5).

Results: Spontaneous closure occurred in 2 patients (40 %). In 3 (60 %) definitive occlusion perineally was needed (the 154th, 270th and 383th day). It was a challenging operation in all – operation time varied from 365 min to 425 min. During the healing period the following complications lead to a long interval to definitive fistula clousure: - previous endoscopic extraction of Hem-o-lok clip from fistula in 1, - proximal urethra marsupialization and bulbar urethral resection in a patient with development of severe stricture during the period when the only bladder diversion was epicystostomy. Definitive fistula repair was followed by closure of the sigmodostomy in an interval of 2– months. All patients are without fistula and continent (0–1 pad daily) after follow-up 1–8 year.

Conclusion: Rectoanastomotic fistula after LRP is serious complication where early urinary and bowel diversion is needed. Under these conditions spontaneous healing is possible. Perineal surgical closure is a challenging and time consuming operation but leads to definitive resolution of this complication.

Keywords:

Laparoscopic radical prostatectomy – rectoanastomotic fistula.

Zdroje

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