title: Laparoscopic approach is feasible in Crohn's complex enterovisceral fistulas: a case-match review.
abstract: 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.
  
  
  METHODS
  This study is a retrospective, case-match review.
  
  
  METHODS
  This study was conducted at a tertiary academic hospital.
  
  
  METHODS
  : 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  This is a retrospective review with a small sample size.
  
  
  CONCLUSIONS
  A laparoscopic approach for complex fistulas is feasible in Crohn's disease, with outcomes similar to those reported for nonfistulizing forms.
authors.affiliation: Department of Digestive Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Université de la Méditerranée, Marseille, France. laura.beyer@ap-hm.fr
authors.forename: Laura
authors.initials: L
authors.lastname: Beyer-Berjot
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Thierry
authors.initials: T
authors.lastname: Bege
authors.forename: Vincent
authors.initials: V
authors.lastname: Moutardier
authors.forename: Christian
authors.initials: C
authors.lastname: Brunet
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Grimaud
authors.forename: Stéphane
authors.initials: S
authors.lastname: Berdah
mesh_terms: D000328:Adult; D002432:Cecum / Q000601:surgery; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult