Mediathek

Abstract

Robotic assisted closure of urethro-rectal fistula with omental flap interposition following laparoscopic prostate adenomectomy

J.-U. Stolzenburg^1, V.K.A. Arthanareeswaran^1
1Universitätsklinikum Leipzig, Leipzig, Deutschland

Introduction: Urethrorectal fistula is an uncommon complication resulting from surgery, radiation or trauma. In this video we present our experience in managing a patient with urethro-rectal fistula following laparoscopic prostate adenomectomy.
Materials and methods: A 71 year old male developed a large urethro-rectal fistula one month following laparoscopic prostate adenomectomy in different hospital. An attempt to close the fistula with a OTSC clip in the previous hospital was unsuccessful. Rectoscopy showed a 3.5cm fistula opening at the level of the prostatic cavity with OTSC clip in situ. We demonstrate our robot assisted surgical technique of closure of urethro-rectal fistula with omental flap interposition. A diversion colostomy was performed in the same sitting.
Results: The patient was placed in supine position in a 20 degree Trendelenburg position. A typical 5 trocar setup was used. The bladder neck was opened ventrally and the clip was removed. A modified radical prostatectomy was performed followed by omental flap mobilization. The large rectal defect was closed using interrupted sutures. The omental flap was fixed posterior to urethra in a tension free manner. The urethrovesical anastomosis was performed in standard manner including lateral narrowing of the bladder neck. Postoperative cystography showed a water tight anastomosis on the 8th postoperative day. Rectoscopy and colostomy closure was performed 3 months later.
Conclusions: Interposition of omental flap during the treatment of complicated fistulas supports the healing process because of its rich vascular and lymphatic supply, together with its resistance to infection. The maneuverability and flexibility of the DaVinci instruments helps the surgeon to perform these fine steps precisely.