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- Title
Optimal surgical management of duodenal fistula in Crohn's disease: a Korean multicenter cohort study.
- Authors
Oh, Soo Young; Kim, Young Il; Yoon, Yong Sik; Cho, Min Soo; Park, Min Young; Ryoo, Seung-Bum; Lee, Jong Lyul; Kim, Chan Wook; Park, In Ja; Lim, Seok-Byung; Yu, Chang Sik
- Abstract
Purpose: Duodenal fistula in Crohn's disease (CDF) is a rare condition with an unclear optimal surgical management approach. We reviewed a Korean multicenter cohort of CDF surgery cases and assessed their perioperative outcomes to evaluate the effectiveness of the surgical interventions. Methods: The medical records of patients who underwent CD surgery between January 2006 and December 2021 from three tertiary medical centers were retrospectively reviewed. Only CDF cases were included in this study. The demographic and preoperative characteristics, perioperative details, and postoperative outcomes were analyzed. Results: Among the initial population of 2149 patients who underwent surgery for CD, 23 cases (1.1%) had a CDF operation. Fourteen of these patients (60.9%) had a history of previous abdominal surgery, and 7 had duodenal fistula at the previous anastomosis site. All duodenal fistulas were excised and primarily repaired via a resection of the originating adjacent bowel. Additional procedures such as gastrojejunostomy, pyloric exclusion, or T-tube insertion were performed in 8 patients (34.8%). Eleven patients (47.8%) experienced postoperative complications including for anastomosis leakages. Fistula recurrence was noted in 3 patients (13%) of which one patient required a re-operation. Biologics administration was associated with fewer adverse events by multivariable analysis (P = 0.026, odds ratio = 0.081). Conclusion: Optimal perioperative conditioning of patients receiving a primary repair of a fistula and resection of the original diseased bowel can successfully cure CDF. Along with primary repair of the duodenum, other complementary additional procedures should be considered for better postoperative outcomes.
- Subjects
CROHN'S disease; FISTULA; COHORT analysis; ABDOMINAL surgery; SURGICAL complications
- Publication
International Journal of Colorectal Disease, 2023, Vol 38, Issue 1, p1
- ISSN
0179-1958
- Publication type
Article
- DOI
10.1007/s00384-023-04387-9