SURGICAL STRATEGY BASED ON 3D RECONSTRUCTION & ARTIFICIAL INTELLIGENCE FOR COMPLEX FISTULAS IN CROHN’S DISEASE: PILOT STUDY
EAES Academy. Pellino G. 07/05/22; 366545; P288
Assoc. Prof. Gianluca Pellino
Contributions
Contributions
Abstract
INTRODUCTION
European Crohn’s and Colitis Organization (ECCO) guidelines propose that the key treatment of perineal Crohn’s disease (PCD) is abscess drainage and tutoring of fistula with setons. However, 80 % of fistulas in these cases are considered as complex with up to 20 % requiring more than two surgical procedures to accomplish these objectives. Endoanal ultrasonography and magnetic resonance images (MRI) are the gold standard as preoperative techniques. Nevertheless, both techniques present specificity values of 80 % to detect main fistula tracts and internal fistula orifices (IFO).
The objective of this study is to evaluate the utility of a 3D reconstruction mathematical model (3DMM) for the surgical strategy in PCD as wells as its capacity to locate abscess, identifying possible IFO and fistula tracts.
MATERIALS AND METHODS:
Two phase study:
Phase 1: analysis of diagnosed patients with PCD in a reference colorectal unit. Assessment of patients current status and the number of necessary surgical procedures to achieve complete abscess drainage and tutoring of fistula tracts.
Phase 2: Evaluate the utility of 3DMM from MRI in patients considered as non-resolved during phase 1. The success assessment was done with post-operative MRI.
RESULTS:
Phase 1: 34 patients were analyzed. The number of mean surgical procedures was of 3.8 per patient. The mean number of interventions to achieve IFO localization was of 2.8. The percentage of fistulas considered as non-resolved was of 70 % with a mean surgical procedures of 4.2.
Phase 2: 3DMM were applied in 4 patients. All of them achieved drainage of abscess zones and IFO located as well as primary and secondary tracts tutored in only one surgical procedure.
CONCLUSIONS:
A 3D reconstruction mathematical method may be useful for the surgical strategy in patients with perineal Crohn’s Disease. This is to decrease the number of procedures needed to drain completely septic fluid collections and locating possible IFO´s and fistula tracts.
European Crohn’s and Colitis Organization (ECCO) guidelines propose that the key treatment of perineal Crohn’s disease (PCD) is abscess drainage and tutoring of fistula with setons. However, 80 % of fistulas in these cases are considered as complex with up to 20 % requiring more than two surgical procedures to accomplish these objectives. Endoanal ultrasonography and magnetic resonance images (MRI) are the gold standard as preoperative techniques. Nevertheless, both techniques present specificity values of 80 % to detect main fistula tracts and internal fistula orifices (IFO).
The objective of this study is to evaluate the utility of a 3D reconstruction mathematical model (3DMM) for the surgical strategy in PCD as wells as its capacity to locate abscess, identifying possible IFO and fistula tracts.
MATERIALS AND METHODS:
Two phase study:
Phase 1: analysis of diagnosed patients with PCD in a reference colorectal unit. Assessment of patients current status and the number of necessary surgical procedures to achieve complete abscess drainage and tutoring of fistula tracts.
Phase 2: Evaluate the utility of 3DMM from MRI in patients considered as non-resolved during phase 1. The success assessment was done with post-operative MRI.
RESULTS:
Phase 1: 34 patients were analyzed. The number of mean surgical procedures was of 3.8 per patient. The mean number of interventions to achieve IFO localization was of 2.8. The percentage of fistulas considered as non-resolved was of 70 % with a mean surgical procedures of 4.2.
Phase 2: 3DMM were applied in 4 patients. All of them achieved drainage of abscess zones and IFO located as well as primary and secondary tracts tutored in only one surgical procedure.
CONCLUSIONS:
A 3D reconstruction mathematical method may be useful for the surgical strategy in patients with perineal Crohn’s Disease. This is to decrease the number of procedures needed to drain completely septic fluid collections and locating possible IFO´s and fistula tracts.
INTRODUCTION
European Crohn’s and Colitis Organization (ECCO) guidelines propose that the key treatment of perineal Crohn’s disease (PCD) is abscess drainage and tutoring of fistula with setons. However, 80 % of fistulas in these cases are considered as complex with up to 20 % requiring more than two surgical procedures to accomplish these objectives. Endoanal ultrasonography and magnetic resonance images (MRI) are the gold standard as preoperative techniques. Nevertheless, both techniques present specificity values of 80 % to detect main fistula tracts and internal fistula orifices (IFO).
The objective of this study is to evaluate the utility of a 3D reconstruction mathematical model (3DMM) for the surgical strategy in PCD as wells as its capacity to locate abscess, identifying possible IFO and fistula tracts.
MATERIALS AND METHODS:
Two phase study:
Phase 1: analysis of diagnosed patients with PCD in a reference colorectal unit. Assessment of patients current status and the number of necessary surgical procedures to achieve complete abscess drainage and tutoring of fistula tracts.
Phase 2: Evaluate the utility of 3DMM from MRI in patients considered as non-resolved during phase 1. The success assessment was done with post-operative MRI.
RESULTS:
Phase 1: 34 patients were analyzed. The number of mean surgical procedures was of 3.8 per patient. The mean number of interventions to achieve IFO localization was of 2.8. The percentage of fistulas considered as non-resolved was of 70 % with a mean surgical procedures of 4.2.
Phase 2: 3DMM were applied in 4 patients. All of them achieved drainage of abscess zones and IFO located as well as primary and secondary tracts tutored in only one surgical procedure.
CONCLUSIONS:
A 3D reconstruction mathematical method may be useful for the surgical strategy in patients with perineal Crohn’s Disease. This is to decrease the number of procedures needed to drain completely septic fluid collections and locating possible IFO´s and fistula tracts.
European Crohn’s and Colitis Organization (ECCO) guidelines propose that the key treatment of perineal Crohn’s disease (PCD) is abscess drainage and tutoring of fistula with setons. However, 80 % of fistulas in these cases are considered as complex with up to 20 % requiring more than two surgical procedures to accomplish these objectives. Endoanal ultrasonography and magnetic resonance images (MRI) are the gold standard as preoperative techniques. Nevertheless, both techniques present specificity values of 80 % to detect main fistula tracts and internal fistula orifices (IFO).
The objective of this study is to evaluate the utility of a 3D reconstruction mathematical model (3DMM) for the surgical strategy in PCD as wells as its capacity to locate abscess, identifying possible IFO and fistula tracts.
MATERIALS AND METHODS:
Two phase study:
Phase 1: analysis of diagnosed patients with PCD in a reference colorectal unit. Assessment of patients current status and the number of necessary surgical procedures to achieve complete abscess drainage and tutoring of fistula tracts.
Phase 2: Evaluate the utility of 3DMM from MRI in patients considered as non-resolved during phase 1. The success assessment was done with post-operative MRI.
RESULTS:
Phase 1: 34 patients were analyzed. The number of mean surgical procedures was of 3.8 per patient. The mean number of interventions to achieve IFO localization was of 2.8. The percentage of fistulas considered as non-resolved was of 70 % with a mean surgical procedures of 4.2.
Phase 2: 3DMM were applied in 4 patients. All of them achieved drainage of abscess zones and IFO located as well as primary and secondary tracts tutored in only one surgical procedure.
CONCLUSIONS:
A 3D reconstruction mathematical method may be useful for the surgical strategy in patients with perineal Crohn’s Disease. This is to decrease the number of procedures needed to drain completely septic fluid collections and locating possible IFO´s and fistula tracts.
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