Intest Res.  2018 Apr;16(2):282-287. 10.5217/ir.2018.16.2.282.

Intraoperative inspection alone is a reliable guide to the choice of surgical procedure for enteroenteric fistulas in Crohn's disease

• Guo Z
• Cai X
• Liu R
• Gong J
• Li Y
• Cao L
• Zhu W

• KMID: 2417680
• DOI: http://doi.org/10.5217/ir.2018.16.2.282

Abstract

BACKGROUND/AIMS
Resection of the diseased segment and suture of the victim segment is recommended for enteroenteric fistula in Crohn's disease (CD). The main difficulty in this procedure remains reliable diagnosis of the victim segment, especially for fistulas found intraoperatively and inaccessible on endoscopic examination. We aimed to explore whether intraoperative inspection alone is reliable.
METHODS
Patients undergoing conservative surgery between 2011 and 2016 for enteroenteric fistulas complicating CD were identified from a prospectively maintained database. Patients were divided according to whether the victim segment was evaluated by preoperative endoscopy + intraoperative inspection (PI group) or by intraoperative inspection alone (I group). Outcomes were compared.
RESULTS
Of 65 patients eligible for the study, 37 were in in the PI group and 28 were in the I group. The baseline characteristics were similar between the groups, except for the rate of emergency surgery (0/37 in PI group vs. 5/28 in I group, P=0.012). Fistulas involved more small intestines (4/37 in PI group vs. 15/28 in I group, P < 0.001) and fewer sigmoid colons (17/37 in PI group vs. 4/28 in I group, P=0.008) in I group due to accessibility with endoscopy. No difference was found in postoperative complications, stoma rates, postoperative recurrence, or disease at the repair site between the 2 groups (P>0.05).
CONCLUSIONS
For fistulas found intraoperatively and inaccessible on endoscopic examination, intraoperative inspection was a reliable guide when choosing between en bloc resection and a conservative procedure.

Keyword

Crohn disease; Enteroenteric fistulas; Surgical procedure

MeSH Terms

Colon, Sigmoid
Crohn Disease*
Diagnosis
Emergencies
Endoscopy
Fistula*
Humans
Intestine, Small
Postoperative Complications
Prospective Studies
Recurrence
Sutures

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