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Laparoscopic Approach Is Feasible in Crohns Complex Enterovisceral Fistulas: A Case-Match Review

Beyer-Berjot, Laura M.D.1; Mancini, Julien M.D.2; Bege, Thierry M.D.1; Moutardier, Vincent M.D., Ph.D.1; Brunet, Christian M.D., Ph.D.1; Grimaud, Jean-Charles M.D., Ph.D.3; Berdah, Stéphane M.D., Ph.D.1

doi: 10.1097/DCR.0b013e31826fedeb
Original Contribution: Inflammatory Bowel Disease

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.

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

Financial Disclosure: None reported.

Poster presentation at the meeting of the European Society of ColoProctology, Copenhagen, Denmark, September 21 to 24, 2011.

Correspondence: Laura Beyer-Berjot, M.D., Service de Chirurgie Digestive, Hôpital Nord, Chemin des Bourrely, 13015 Marseille, France. E-mail: laura.beyer@ap-hm.fr

© The ASCRS 2013