V02-08 Robot-Assisted Single Port Transvesical Repair of Colovesical Fistula Using Acellular Dermal Matrix Graft Interposition

You have accessJournal of UrologyFemale Voiding Dysfunction/ Pelvic Floor Disorders/ Incontinence/ Neuro-Urology (V02)1 May 2024V02-08 ROBOT-ASSISTED SINGLE PORT TRANSVESICAL REPAIR OF COLOVESICAL FISTULA USING ACELLULAR DERMAL MATRIX GRAFT INTERPOSITION Elizabeth Ellis, Rabih Salloum, Jean Joseph, and Divya Ajay Elizabeth EllisElizabeth Ellis , Rabih SalloumRabih Salloum , Jean JosephJean Joseph , and Divya AjayDivya Ajay View All Author Informationhttps://doi.org/10.1097/01.JU.0001008636.33664.3e.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Surgical options after failed colovesical fistula repairs in patients whom trans-abdominal surgery is contraindicated are limited. We present a technique using a robot assisted single port transvesical fistula repair using an acellular dermal matrix (ADM) graft interposition after a failed transperineal fistula repair with gracilis flap interposition in a patient who had multiple colorectal surgeries and pelvic radiation. His performance status was 1 and he had a 300 cc bladder capacity. METHODS: The patient was placed in the dorsal lithotomy position and rigid cystoscopy was performed demonstrating a fistula adjacent to the right ureteral orifice. We placed bilateral ureteral stents for intraoperative identification of the ureters. Two foley catheters were placed in the rectum – one proximal and the other distal to the fistula. The balloons were inflated to maintain a proper seal to aid insufflation. A 3 cm skin incision was made approximately 2 finger-breadths over the pubic bone, which was carried down to the bladder. 0-Vicryl stay sutures were placed in the bladder. The bladder was opened. The Intuitive SP access port was used with the wound protector inserted into the bladder; the SP robot was docked. The fistula tract was identified and opened circumferentially. Bladder flaps were created. We identified a 3 cm opening in the rectum which was freed this from the bladder. We closed the rectum with 4-0 PDS and imbricated with 2-0 vicryl. We leak tested the rectal repair using air from the foley catheter. A 3x7 sheet of thin ADM was placed over the rectum and secured with 4-0 PDS. The bladder was closed in 2 layers using 3-0 PDS and 4-0 PDS. The ureteral stents were manipulated to ensure ureteral patency. A foley catheter was placed and the ureteral stents were removed. The cystotomy was repaired in 2 layers. The bladder was leak tested through the foley catheter and satisfactory. Fascia and skin were closed. RESULTS: A cystogram was performed four weeks post-op and there was no evidence of a persistent colovesical fistula so the catheter was removed. Bilateral low grade ureteral reflux was noted which was also present pre-operatively. There was no hydronephrosis. At 6 month follow up the patient was fully continent, and had no signs and symptoms suggestive of a residual or recurrent fistula. CONCLUSIONS: Robot-assisted single port transvesical repair of colovesical fistula using ADM graft interposition is a safe and effective surgical option for patients with prior failed fistula repairs and in whom trans-peritoneal surgery is contraindicated. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e102 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Elizabeth Ellis More articles by this author Rabih Salloum More articles by this author Jean Joseph More articles by this author Divya Ajay More articles by this author Expand All Advertisement PDF downloadLoading ...