Laparoscopic Surgery For Crohns Disease
03.21.10
The rate of conversion from laparoscopic to open surgery was 11.2 percent. Laparoscopic procedures took longer to perform compared with open procedures, with a weighted mean difference of 25.54 minutes. Patients who underwent laparoscopic surgery had a more rapid recovery of bowel function, with a weighted mean difference of 0.75 days and were able to tolerate oral intake earlier, with a weighted mean difference of 1.43 days .
The duration of hospitalization was shorter, with a weighted mean difference of 1.82 days. Morbidity was lower for laparoscopic procedures compared with open procedures (odds ratio, 0.57; 95 percent confidence interval, 0.37-0.87). The rate of disease recurrence was similar for both laparoscopic and open surgery.
Laparoscopic surgery for Crohns disease takes longer to perform, but there are significant short-term benefits to the patient. The morbidity also is lower, and the rate of disease recurrence is similar. Therefore, laparoscopic surgery for Crohns disease is both safe and feasible.
An effort was made to assess the feasibility, safety, and outcome of laparoscopic procedures performed in patients with Crohns disease. Methods: A prospectively maintained laparoscopic database was analyzed regarding operation time, intra- and postoperative complications, conversion to laparotomy, and length of hospitalization.
Fifty-one patients (23 males and 28 females) with a mean age of 36 (20-79) years underwent a laparoscopic or laparoscopic-assisted procedure for Crohns disease. The indications included terminal ileitis in 31 patients, colitis in 11, perianal disease in four, duodenal Crohns disease in three, and rectovaginal and rectourethral fistula in one patient each.
Thirty-two patients underwent an ileocolic resection; total abdominal colectomy with ileorectal anastomosis was performed in six patients with end ileostomy in one, take down of end ileostomy and ileorectal anastomosis in three, duodenal bypass gastrojejunostomy in three, and loop ileostomy in six patients.
Results: The mean operating time was 2.4 (0.6-4.5) h and the mean length of hospital stay was 5.1 (3-18) days. Eight complications were noted in seven patients (14%), which included enterotomy in two patients, bleeding in two, stoma obstruction in two, pelvic sepsis in one, and efferent limb obstruction in one. The procedure was converted to laparotomy in seven patients (14%) due to a large inflammatory mass in five and to bleeding in two patients; there was no mortality.
Conclusion: Laparoscopic surgery is a feasible, versatile, and safe modality in the surgical management of Crohns disease. Despite the often-malnourished state of these steroid-dependent patients with intraabdominal inflammatory conditions, morbidity, procedural length, and length-of-hospitalization data are all similar to results previously reported for less-challenging laparoscopic colorectal procedures.
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