A case of fistulating disease involving the terminal ileum and sigmoid colon-A video vignette.

AIMS: This video presents a case involving complex inflammatory bowel disease (IBD) with fistulation of the terminal ileum and sigmoid colon. We aim to discuss an overview of the decision-making involved in the pre-operative, intra-operative and post-operative stages, while highlighting the benefits of utilising a robotic platform.

METHODS

A 29-year-old patient with Crohn's disease underwent a robotic ileo-colic resection without anastomosis and double barrel ileostomy formation. A multidisciplinary approach was taken with regard to surgical planning. Pre-operative dietician and gastroenterology input optimised nutritional status and continued biologic therapy. Involvement with radiology was key; an MRI for surgical planning was reviewed in combination with the radiologist to determine the nature of the disease.

RESULTS

The intra-operative video discusses factors pertaining to robotic surgery, including port placement and extraction site planning. The salient intra-operative stages are highlighted, and nuances of IBD-specific robotic techniques are discussed. The importance of pre- and intra-operative factors in IBD surgery is explored; biologic and steroid use, nutritional status, exclusive enteral nutrition, consideration for fistulating disease and adapting ports to stoma and extraction sites. Post-operative surveillance is discussed, including current practice with tattooing and severity scores, in addition to ongoing research utilising artificial intelligence to improve the ability to detect recurrence.

CONCLUSION

This video presents a case of an ileo-sigmoid fistula related to Crohn's disease. Optimisation strategies for the pre-operative, intra-operative and post-operative phases are discussed. The benefits of a robotic platform with respect to the challenges of IBD surgery are demonstrated.