The laparoscopic management of benign bowel fistulas.
BACKGROUND
The presence of a fistula has usually been a factor predicting high conversion and complication rates following laparoscopic procedures for Crohn's disease and diverticulitis.


METHODS
We studied retrospective data collected from the medical case notes of patients. A single surgeon carried out all these procedures from 1991 through 2001.


RESULTS
Fourteen patients underwent 15 procedures. Six patients were males and 8 were females. The diagnosis was Crohn's disease in 10 patients and diverticulitis in 4. In 10 cases, the operation was the primary procedure, but 5 procedures were for recurrences. Two patients with diverticulitis and 3 with Crohn's disease had only the fistulae divided with the application of an Endo-GIA stapier across the fistulae (stapled fistulectomy). No bowel resections were carried out in these 5 patients. Four cases had to be converted due to bleeding (23%). The only postoperative complication was a single case of wound infection after conversion.


CONCLUSIONS
The presence of a fistula isn't necessarily an indication for conversion. If it is possible to dissect the loops free, we believe that a stapled fistulectomy is effective with a low incidence of fistula recurrence, especially in Crohn's disease.
Moorthy
K
K
Department of Surgery, Bedford Hospital, Bedford, United Kingdom. k.moorthy@ic.ac.uk
Shaul
T
T
Foley
R J E
RJ
D003424:Crohn Disease / Q000150:complications* / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology* / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods