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P396. Outcomes of surgical treatment of entero-urinary fistulas in Crohn's disease

I. Fernández-Blanco1, C. Taxonera2,3, G. Bastida4, V. García-Sánchez5, M. Gómez-García6, I. Marín-Jiménez7, E. Iglesias5, J.P. Gisbert8,9, M. Barreiro-de Acosta10, F. Bermejo11, M.J. Casanova8,9, C. Saro12, P. López-Serrano13, R. Plaza14, A. Algaba11, D. Olivares2,3, J.L. Mendoza2,3, 1Hospital Moncloa, Gastrointestinal Surgery, Madrid, Spain, 2H Clinico San Carlos, IdISSC, Madrid, Spain, 3H Clinico San Carlos, IBD Unit, Madrid, Spain, 4H La Fe, Service of Gastroenterology, Valencia, Spain, 5H Reina Sofía, Service of Gastroenterology, Córdoba, Spain, 6H Virgen de las Nieves, Service of Gastroenterology, Granada, Spain, 7H Gregorio Marañón, Service of Gastroenterology, Madrid, Spain, 8IP, CIBERehd, Madrid, Spain, 9H La Princesa, Gastroenterology Unit, Madrid, Spain, 10H Clinico de Santiago, Service of Gastroenterology, Santiago de Compostela, Spain, 11H Fuenlabrada, Service of Gastroenterology, Madrid, Spain, 12H de Cabueñes, Service of Gastroenterology, Gijón, Spain, 13H Alcorcón, Service of Gastroenterology, Madrid, Spain, 14H Infanta Leonor, Service of Gastroenterology, Madrid, Spain

Background

Entero-urinary fistula (EUF) is a rare complication of Crohn's disease (CD). Most studies of EUF in CD are relatively small. The aim of the study was to evaluate the short and long-term outcomes of surgical treatment for inducing remission of EUF in a large cohort of CD patients.

Methods

A retrospective search in prospectively maintained databases was performed for CD patients with EUF who underwent surgery. EUFs were diagnosed by the clinical presentation and imaging techniques and confirmed at surgery. We defined remission as the absence of presenting symptoms of EUFs. Surgery type, outcome and rate of post-surgical complications and recurrences were evaluated.

Results

Of the 75 patients with EUF included, 56 (75%) were male. Mean (SD) age at diagnosis was 35 (15) and median (IQR) disease duration was 24 months (1–84). Previous fistula treatments included antibiotics (45 [60%]), immunosuppressants (37 [50%]) and anti-TNF therapy (18 [24%]). The site of fistula was terminal ileum in 46 (61%), followed by colon in 19 (25%) and rectum in 4 (6%). Urinary tract lesions were located in the bladder in 69 (92%) patients. The indication for surgery was EUF alone in 35 (47%), abdominal indication alone 6 (8%), and both in 34 (45%). In 12 (16%) patients, laparoscopic surgery was attempted, with 4 (33%) requiring switch to open surgery. Other intraoperative findings included abscesses (17 [23%]), pseudotumoural masses (44 [59%]) and other fistula (24 [32%]). Most patients (n = 70 [93%]) underwent one-stage surgery with intestinal resection and closure of the bladder defect. In 5 (7%) patients, temporal ostomy (3 ileostomy, 2 colostomy) was required. Mean (SD) duration of hospital stay was 14 (9) days for open surgery and 7 (3) days for laparoscopic access (p < 0.001). Mean time to oral feeding was shorter for laparoscopic surgery (3 vs 5 days, p < 0.001). Early post-surgical complications occurred in 9 (12%) patients (4 abdominal abscesses, 2 anastomotic leakages, 3 haemorrhages). Two patients (3%) had late post-surgical complications (1 abscess and 1 intestinal obstruction). No deaths or EUF recurrences were reported. After surgery, patients received an immunomodulator (33 [44%]), anti-TNF therapy (3 [4%]) or both (21 [28%]). At the last follow-up visit, all patients were in sustained remission (median [IQR] follow-up from surgery 114 months [49–162]).

Conclusion

Surgical treatment for EUF is a safe and effective procedure, with no recurrences and a low rate of complications. All patients had achieved remission at the last follow-up visit. Mean times to oral feeding or hospital discharge were significantly shorter for laparoscopic surgery, with no differences for other outcomes.