Should enteric fistulas from Crohn's disease or diverticulitis be treated laparoscopically or by open surgery? A matched cohort study

PURPOSE: The aim of this study was to study a group of consecutive patients with enteric fistulas treated by laparoscopic surgery and to compare outco mes with a matched group of patients treated by open surgery. METHODS: The outcomes of 13 patients with Crohn's disease or sigmoid diverticulitis with enteric fistulas treated laparoscopically (Group I) were compared with 13 patients matched for age, weight, gender, diagnosis, and characteristics of fistulas and treated by conventional surgery (Group II) during the same pe riod. RESULTS: No patient died postoperatively in either group. Mean operat ive time was 183 minutes in Group I vs. 154 minutes in Group II (P = 0.280) . No significant difference was found between Groups I and II in the number of patients with major postoperative complications (3 vs. 5; P = 0.462), o r postoperative stay (7.6 +/- 3.6 vs. 9.2 +/- 3 days; P = 0.239). Conversio n to open laparotomy occurred in one (7.7 percent) patient from Group I. No patient required readmission for secondary surgery in Group I, and two pat ients were readmitted and underwent reoperation for complications in Group II (P = 0.462). CONCLUSIONS: The laparoscopic treatment of selected cases o f enteric fistulas is safe. Although most good outcome trends favor the lap aroscopic group, the study is inconclusive, because no statistical differen ce was demonstrated with regard to operative time, number of postoperative complications, readmission rate, and length of postoperative stay, most lik ely because of the small number of cases in each arm of the study. Study of a greater number of cases outside the learning curve of the laparoscopic s urgeons would clarify this issue. Other outcomes, including cost, pain cont rol, cosmesis, and return to activities of daily living, need to be include d in the evaluation.