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: 3.2). 02/2013; 56(2):191-7. DOI: 10.1097/DCR.0b013e31826fedeb
Source: PubMed

ABSTRACT : 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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