A drawback of the ACS-NSQIP database is that only one diagnosis, the principal diagnosis is recorded, which inevitably results in underreporting of these fistulae. Also, we are not able to distinguish the underlying cause for the fistulae; diverticulitis, malignancy, inflammatory bowel disease, or other.

Methods

The ACS-NSQIP includes data related to surgeries from *** hospitals in the United States.
We identified all patients who underwent abdominal surgery for the principal diagnosis of intestinovesical fistula (ICD-9 code ***). These include laparoscopic and open bowel resections of any kind, and fecal diversion. We excluded all perineal procedures, such as perineal repair of rectovaginal fistula.

Statistics

Results

Discussion

Intestinovaginal fistula is rare with accumulated knowledge to date only from case reports and case series. The incidence of diverticulitis is rising in the United States, and as diverticulitis is the most common cause of intestinovaginal fistula, the rates of these fistulas can hence be expected to increase. Surgery is the treatment of choice, unless contraindicated for medical reasons and restoration to full health not feasible.
Laparoscopy rates have been increasing for colon cancer and for diverticulitis, but is the laparoscopy rate for  intestinovaginal fistula increasing in the same manner? Stoma rates for colon cancer and diverticulitis are **%, and reported as **% for fistulizing disease. 
Complication rates are lower in laparoscopy compared to open surgery for both diverticulitis and colon cancer. This has not been shown in intestinovesical fistula????*** We wished to understand what determines how we surgically treat these patients, and if the laparoscopic approach is safe or safer than open.
Laparoscopy has been shown to be beneficial in many surgical conditions in terms of length of stay, return to work, post-operative pain, etc, but is it beneficial in the management of intestinovesical fistula?
A drawback with ACS-NSQIP is that only one ICD code is recorded for each patient, precluding the question of etiology of the fistula. 

Conclusions