Urologic complications during hartmann reversal procedure: Robotic-assisted management of two cases of enterovesical fistulae

You have accessJournal of UrologyCME1 Apr 2023V08-04 UROLOGIC COMPLICATIONS DURING HARTMANN REVERSAL PROCEDURE: ROBOTIC-ASSISTED MANAGEMENT OF TWO CASES OF ENTEROVESICAL FISTULAE Jaime Poncel, Aref S. Sayegh, Alexandre K. Hidaka, Maria A. Lizana, Sij Hemal, Luis G. Medina, and Rene Sotelo Jaime PoncelJaime Poncel More articles by this author , Aref S. SayeghAref S. Sayegh More articles by this author , Alexandre K. HidakaAlexandre K. Hidaka More articles by this author , Maria A. LizanaMaria A. Lizana More articles by this author , Sij HemalSij Hemal More articles by this author , Luis G. MedinaLuis G. Medina More articles by this author , and Rene SoteloRene Sotelo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hartmann procedure is the resection of the rectosigmoid colon, closure of the rectal stump, and creation of an end colostomy. Unfortunately, a Hartmann reversal to re-establish intestinal continuity carries high morbidity with a complication rate of up to 58%. Urological complications during Hartmann’s reversal procedure are rare however low rates of bladder injury (8.16-16%) and fistula formation (0.6-4.08%) have been reported in the literature. This video presents a step-by-step robotic surgical technique for the repair of two entero-vesical fistulae likely caused due to the incorrect use of the circular surgical stapler during a Hartmann’s reversal. METHODS: Two consecutive cases of entero-vesical fistulae were treated through a novel robotic transabdominal approach by a single surgeon. Surgical steps were performed as illustrated in the video. Perioperative and functional outcomes were evaluated and reported. Continuous variables were reported as median and quartiles, whereas categorical variables were presented as frequencies and percentages. RESULTS: Two cases are reported with a median age of 71 (59-83). Both surgeries were uneventful with no intraoperative complications reported. Median operative time estimated blood loss, and length of stay were 557 (454-660) minutes, 150 (100-200) cc, and 3 (2-4) days, respectively. Median Jackson-Pratt drain removal time was 6.5 (4-9) days. Median catheter removal time was 18 (14-22) days. One case of urinary tract infection occurred during the postoperative period, which was successfully treated. No fistula recurrence was reported. CONCLUSIONS: Hartmann reversal is a morbid procedure that carries a small risk of urological complications, which may have a significant impact on patient's quality of life. Herein, we present the robotic-assisted management of enterovesical fistula formation following two Hartmann reversals and demonstrate the feasibility and safety of utilizing a minimally invasive approach. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e749 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaime Poncel More articles by this author Aref S. Sayegh More articles by this author Alexandre K. Hidaka More articles by this author Maria A. Lizana More articles by this author Sij Hemal More articles by this author Luis G. Medina More articles by this author Rene Sotelo More articles by this author Expand All Advertisement PDF downloadLoading ...