Laparoscopic approach is feasible in Crohn's complex enterovisceral fistulas: a case-match review
Laura Beyer-Berjot1, Julien Mancini, Thierry Bege
1Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France. laura.beyer@ap-hm.fr
Insights
Laparoscopic surgery for complex enterovisceral fistulas in Crohn's disease is feasible. Outcomes were comparable to nonfistulizing Crohn's disease, demonstrating safety and efficacy.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Inflammatory Bowel Disease Management
Background:
- Complex enterovisceral fistulas involve internal connections between diseased and other intra-abdominal organs, excluding ileoileal fistulas.
- Laparoscopic surgery for these complex fistulas in Crohn's disease is infrequently documented.
Purpose of the Study:
- To assess the feasibility of a laparoscopic approach for complex enterovisceral fistulas in Crohn's disease patients.
- To compare outcomes of laparoscopic surgery for complex fistulas against those for nonfistulizing Crohn's disease.
Main Methods:
- Retrospective, case-matched review of patients undergoing laparoscopic ileocecal resection for complex enterovisceral fistulas.
- Matching controls with nonfistulizing Crohn's disease based on age, sex, nutritional status, steroid use, and resection type.
- Comparison of operative time, conversion rates, morbidity, mortality, and length of stay between groups.
Main Results:
- Eleven patients with 13 complex fistulas were matched with 22 controls.
- No significant differences observed in operative time, conversion to open surgery, stoma creation, or global postoperative morbidity.
- Similar rates of major complications and length of stay between the fistula and non-fistula groups; no mortality reported.
Conclusions:
- Laparoscopic surgery for complex enterovisceral fistulas in Crohn's disease is a feasible approach.
- Outcomes are comparable to those for nonfistulizing forms of Crohn's disease.
- This study, though limited by sample size, supports the use of laparoscopy in managing complex fistulas.
Background:
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.
Objective:
The aim of this study was to evaluate the feasibility of such an approach.
Design:
This study is a retrospective, case-match review.
Settings:
This study was conducted at a tertiary academic hospital.
Patients:
: 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.
Main Outcome Measures:
The 2 groups were compared in terms of operative time, conversion to open surgery, morbidity and mortality rates, and length of stay.
Results:
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.
Limitations:
This is a retrospective review with a small sample size.
Conclusion:
A laparoscopic approach for complex fistulas is feasible in Crohn's disease, with outcomes similar to those reported for nonfistulizing forms.
