Department of Surgery C.
Minimally Invasive and Robotic Surgery, Sheba Medical Center, Tel Hashomer.
Surg Laparosc Endosc Percutan Tech. 2021 Mar 12;31(5):539-542. doi: 10.1097/SLE.0000000000000928.
In primary Crohn's disease (CD), laparoscopic ileocolic resection has been shown to be both feasible and safe, and is associated with improved outcomes in terms of postoperative morbidity and length of hospital stay. However, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with complex enterovisceral fistulas.The aim of this study is to assess the feasibility and safety of laparoscopic surgery for complex enterovisceral fistulas, and compare it with CD patients who underwent primary laparoscopic ileocolic resection.
All patients who underwent laparoscopic primary ileocolic resection (LICR) for complex enterovisceral fistulas between July 2006 and July 2017 were included. They were compared with all consecutive patients who underwent LICR for nonfistulizing CD in the same period of time. Patients with previous bowel resections or recurrent disease were excluded.
Nineteen patients with 20 enterovisceral fistulas (group I) were compared with 61 patients who underwent LICR for nonfistulizing disease (group II). There were no differences between the groups in age, sex, preoperative body mass index, nutritional status, and American Society of Anesthesiology score. There was no conversion to open surgery in both groups.There were no significant differences between groups in terms of operative time [120 (range: 65 to 232) vs. 117 (range: 62 to 217) min, P=0.7], hospital stay [6 (5 to 8) vs. 7 (5 to 65) days, P=0.56], overall morbidity 26.3% versus 16.4% (P=0.33), major morbidity (Clavien-Dindo >3) 15.7% versus 10% (P=0.66) and reoperation rates 5.3% versus 4.9% (P=0.9). There was no mortality in both groups.
Our experience shows that the laparoscopic approach for complex enterovisceral fistulas in selected CD patients is both feasible and safe in the hands of experienced inflammatory bowel disease surgeons with extensive expertise in laparoscopic surgery. Larger study cohorts are needed to confirm these findings.
在原发性克罗恩病（CD）中，腹腔镜回结肠切除术已被证明是可行且安全的，并且与术后发病率和住院时间的改善相关。然而，对于伴有复杂肠内瘘的患者，腹腔镜方法是否可以常规作为安全的手术方式尚不清楚。本研究旨在评估腹腔镜手术治疗复杂肠内瘘的可行性和安全性，并将其与接受原发性腹腔镜回结肠切除术（LICR）的 CD 患者进行比较。
纳入 2006 年 7 月至 2017 年 7 月期间接受腹腔镜原发回结肠切除术（LICR）治疗复杂肠内瘘的所有患者。并将其与同期接受 LICR 治疗非瘘管性 CD 的所有连续患者进行比较。排除有既往肠切除术或复发性疾病的患者。
19 例 20 例肠内瘘患者（组 I）与 61 例接受非瘘管性疾病 LICR 的患者（组 II）进行比较。两组患者的年龄、性别、术前体重指数、营养状况和美国麻醉医师协会评分无差异。两组均无中转开腹手术。组间手术时间[120（范围：65 至 232）分钟比 117（范围：62 至 217）分钟，P=0.7]、住院时间[6（5 至 8）天比 7（5 至 65）天，P=0.56]、总并发症发生率 26.3%比 16.4%（P=0.33）、主要并发症（Clavien-Dindo >3）发生率 15.7%比 10%（P=0.66）和再手术率 5.3%比 4.9%（P=0.9）均无显著差异。两组均无死亡病例。
我们的经验表明，对于具有丰富腹腔镜手术经验的经验丰富的炎症性肠病外科医生，在选择的 CD 患者中，腹腔镜治疗复杂肠内瘘的方法是可行且安全的。需要更大的研究队列来证实这些发现。
