Laparoscopic Approach Is feasible in Crohn's Complex Enterovisceral Fistulas: A Case-Match Review

1 Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France 2 Department of Public Health, Hôpital la Timone, Assistance Publique - Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France 3 Department of Gastroenterology, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France.
Diseases of the Colon & Rectum (Impact Factor: 3.75). 02/2013; 56(2):191-7. DOI: 10.1097/DCR.0b013e31826fedeb
Source: PubMed


: Complex enterovisceral fistulas are internal fistulas joining a "diseased" organ to any intra-abdominal "victim" organ, with the exception of ileoileal fistulas. Few publications have addressed laparoscopic surgery for complex fistulas in Crohn's disease.
: The aim of this study was to evaluate the feasibility of such an approach.
: This study is a retrospective, case-match review.
: This study was conducted at a tertiary academic hospital.
: All patients who underwent a laparoscopic ileocecal resection for complex enterovisceral fistulas between January 2004 and August 2011 were included. They were matched to a control group undergoing operation for nonfistulizing Crohn's disease according to age, sex, nutritional state, preoperative use of steroids, and type of resection performed. Matching was performed blind to the peri- and postoperative results of each patient.
: The 2 groups were compared in terms of operative time, conversion to open surgery, morbidity and mortality rates, and length of stay.
: Eleven patients presenting with 13 complex fistulas were included and matched with 22 controls. Group 1 contained 5 ileosigmoid fistulas (38%), 3 ileotransverse fistulas (23%), 3 ileovesical fistulas (23%), 1 colocolic fistula (8%), and 1 ileosalpingeal fistula (8%). There were no significant differences between the groups in terms of operative time (120 (range, 75-270) vs 120 (range, 50-160) minutes, p = 0.65), conversion to open surgery (9% vs 0%, p = 0.33), stoma creation (9% vs 14%, p = 1), global postoperative morbidity (18% vs 32%, p = 0.68), and major complications (Dindo III: 0% vs 9%, p = 0.54; Dindo IV: 0% vs 0%, p = 1), as well as in terms of length of stay (8 (range, 7-32) vs 9 (range, 5-17) days, p = 0.72). No patients died.
: This is a retrospective review with a small sample size.
: A laparoscopic approach for complex fistulas is feasible in Crohn's disease, with outcomes similar to those reported for nonfistulizing forms.

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    • "110 patients 113 procedures (68 completed vs. 45 converted) Alves et al. 2005 P 69 (all lap) Moorthy et al. 2004 R 48 (57 procedures) Canedo et al. 2010 R 213 (all lap) Fistulizing and recurrent Crohn's disease Goyer et al. 2009 P 124 (54 complex vs. 70 non-complex) Okabayashi et al. 2007 R 107 patients, 91 lap procedures Melton et al. 2009 R 104 (29 lap vs. 75 open) Uchikoshi et al. 2004 R 43 (23 lap vs. 20 open) Holubar et al. 2010 R 40 (30 lap vs. 10 converted) Brouquet et al. 2010 R 57 patients, 62 reoperations (29 lap vs. 33 open) Pinto et al. 2011 R 130 (50 recurrent vs. 80 primary operations) Aytac et al. 2012 R 52 (26 lap vs. 26 open) Huang et al. 2012 R 130 (48 with prior surgery vs. 82 without prior surgery) Beyer-Berjot et al. 2013 R 33 (13 with fistula vs. 22 controls) Alternative specimen extraction techniques Holder-Murray et al. 2012 P 83 (52 lap vs. 32 open) Kroesen et al. 2008 R 8 Eshuis et al. 2010 R 10 Gardenbroek et al. 2012 R 10 Intracorporeal anastomosis Bergamaschi et al. 2009 P 80 lap ileocolic resections El-Gazzaz et al. 2010 R 456 with Crohn's disease (228 lap vs. 228 open) Chang et al. 2012 R 84 with Crohn's disease (all lap) Single incision Rijcken et al. 2012 SR 150 Rijcken et al. 2012 R 20 (10 SILS vs. 10 lap) Moftah et al. 2012 R 5 with Crohn's disease (all SILS) M meta-analysis, SR systematic review, PRCT prospective randomized controlled trial, P prospective study, R retrospective study, lap laparoscopic, SILS single-incision laparoscopic surgery, HALS hand-assisted laparoscopic surgery, open conventionally operated patients "
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