Laparoscopic treatment of enteric fistulas

Background: Elective laparoscopically assisted sigmoid colectomy for diverticular disease and ileocolic resection for terminal ileal Crohn's disease are safe and beneficial procedures in many patients. However, few data exist regarding the laparoscopic management of enteric fistulas from diverticular and Crohn's disease. Methods: We completed a retrospective chart review of patients who underwent laparoscopic treatment of enteric fistulas complicating diverticular and Crohn's disease. Results: During an 8-year period (1994-2002), 72 patients underwent 73 laparoseopically assisted bowel resections for enteric fistulas by one surgeon at the Mount Sinai Medical Center. Ninety percent of patients had Crohn's disease, the average age was 39, and the male/ female ratio was 38/34. Patients had a history of prior abdominal surgery in 39.7% of cases. Multiple fistulas were present in 30% of patients and 12.3% underwent multiple resections at the time of operation. Mean operating time was 199 min, and the conversion rate was 4.1%. Average length of stay was 5.2 days. There were no mortalities in the series. Overall morbidity was 11%. Conclusions: Laparoscopic management of enteric fistula disease is safe and effective. Low morbidity and short hospital stay demonstrate the safety and benefit of the minimally invasive approach for even complicated fistula disease in patients with history of prior abdominal surgery and multiple fistulas, or in patients requiring multiple resections for fistulas from diverticular and Crohn's disease.