Abstract
Background
Radiation-induced rectovaginal fistula (RI-RVF) is a distressful condition after radiotherapy for pelvic malignancies. Diverting colostomy is an effective procedure for improving the quality of life. The aim of this study was to compare the surgical outcomes of laparoscopic diverting colostomy with open surgery for RI-RVF.
Methods
66 patients developed RI-IVF after pelvic radiation for malignancies between January 2014 and December 2023 were retrospectively collected and analyzed, among which 28 patients received laparoscopic diverting colostomy and 38 patients undergone open surgery. A comparison of clinical features between the two groups was made initially. We also assessed the surgical and postoperative outcomes according to the approach used for diverting colostomy.
Results
The postoperative length of stay is significantly shorter in the laparoscopic group (6 ± 2.43 days) than in the open group (8 ± 3.33 days, p < 0.01). Laparoscopic surgery was associated with shorter length of incision (p < 0.01), lower pain score (p < 0.01), less days requiring analgesics (p < 0.01) and lower rate of surgical site infection (p = 0.04). There were no statistically significant differences between the two groups in terms of surgery time, blood loss, ICU admission, time to pass first flatus or defecation, to resume liquid or normal diet.
Conclusions
Laparoscopic diverting colostomy is feasible for patients with RI-RVF, albeit adhesions in the peritoneal cavity. Compared to open procedures, patients received laparoscopic surgery had a shorter length of hospital stay and lower incidence of surgical site infections. Previous surgical and radiation history is not a contraindication for laparoscopic colostomy, hence laparoscopic approach can be implemented safely in patients with RI-RVF.