Intest Res  
Intraoperative inspection alone is a reliable guide to the choice of surgical procedure for enteroenteric fistulas in Crohn’s disease
Zhen Guo1, Xingchen Cai2, Ruiqing Liu1, Jianfeng Gong1, Yi Li1, Lei Cao1, Weiming Zhu1
1Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 2Department of General Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, China
Correspondence to: Weiming Zhu, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, China. Tel: +86-25-80860036, Fax: +86-25-80860220, E-mail:
Received: September 25, 2017; Revised: November 21, 2017; Accepted: December 4, 2017; Published online: February 22, 2018.
© Korean Association for the Study of Intestinal Diseases. All rights reserved.

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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=0.0119). Fistulas involved more small intestines (4/37 in PI group vs. 15/28 in I group, P=0.0003) and fewer sigmoid colons (17/37 in PI group vs. 4/28 in I group, P=0.0081) 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.
Keywords: Crohn disease; Enteroenteric fistulas; Surgical procedure

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