Complications after intestinal resection in Crohn's disease: laparoscopic versus conventional approach

Abstract

Background significant advances in medical therapy for Crohn's disease (CD) occurred in the last 12 years, mainly due to the introduction of anti-TNF therapy. Laparoscopic colorectal surgery represented the most important advance on surgical treatment in the management of CD, as it also had developed in the treatment of other conditions. There is a tendency for lower complication rates after laparoscopic bowel resections as compared to open surgery. The aim of this study was to analyze and compare the complication rates after bowel resections for CD between the two approaches in a Brazilian case series. Methods this was a retrospective longitudinal study, including CD patients submitted to bowel resections from a single Brazilian Inflammatory Bowel Diseases (IBD) referral center, treated between January 2008 and June 2012 with laparoscopic approach (LA) or conventional approach (CA). Variables analyzed age at surgery, gender, Montreal classification, smoking, concomitant medication, type of surgery, surgical approach, presence and type of complication up to 30 days after the procedures. Readmission and reoperation rates, as well as mortality, were also analyzed. Patients were allocated in two groups regarding the type of procedure (LA or CA), and complication rates and characteristics were compared. Statistical analysis was performed with Mann-Whitney test (quantitative variables) and chi-square test (qualitative variables), with p < 0.05 considered significant. Results a total of 46 patients (25 men) were included (16 submitted to LA), with mean age of 38.1 (± 12.7) years. The groups were considered homogeneous according to age, gender, CD location, perianal disease and concomitant medications. There were more patients with fistulizing CD on the CA group (p = 0.029). The most common procedure performed was ileocolic resection on both groups (56.7% of the CA and 75% of the LA patients – p = 0.566). Overall, total complications (surgical and medical, including minor and major issues) occurred in 60% (18/30) of the CA group and 12.5% (2/16) of the LA group (p = 0.002). Wound infection was the most frequent complication (10/30 on CA and 1/16 on the LA groups). There were 3 deaths in the CA group. Specific analysis of each complication did not demonstrate any difference between the groups regarding abdominal sepsis, urinary tract infections, pneumonia, readmission, reoperations and deaths (p = 0.074). Conclusions there was a higher complication rate in patients operated with CA as compared to LA. This was probably due to patient selection for the laparoscopic approach, with severe cases, mostly due to fistulizing abdominal CD, being operated mainly by open surgery. LA tends to be the recommended approach in most cases of non-complicated CD.

Analysis of Risk Factors and Postoperative Complications in Patients With Crohn’s Disease

“…The rate of postoperative complications was 40.9% (18 complicated surgeries, out of 44), which is consistent with the rates reported in the literature (13,21,22) . The fact that the hospital in which the study was conducted is the only tertiary referal hospital for the entire midwest of the state of São Paulo, which comprehend more than 2 million people, may explain the relatively high value of complications.…”

“…However, it was not possible to study the difference between the surgical approaches, since all the surgeries performed in the present study had a conventional approach. The need for reoperation is also lower in laparoscopic approach surgeries, according to the literature (13) . Although it is available in our group, the hospital cost policy difficult the use of laparoscopy, especially at the time when the study was conducted.…”

“…The literature reports (13) a lower rate of postoperative complications in laparoscopic surgeries, especially in cases of mild to moderate non-fistulizing CD. However, it was not possible to study the difference between the surgical approaches, since all the surgeries performed in the present study had a conventional approach.…”

“…The gender distribution of the patients in this study is similar the one reported in the literature (19) . The ileocolonic location is the most common among patients undergoing conventional (open) surgery for CD in several studies found in the literature (13,20) . The highest incidence of CD between 12 and 40 years of age (A2 of Montreal) is also reported in the literature as the most common among patients requiring surgery (13) .…”

“…Rogério SAAD HOSSNE 1 , Ligia Yukie SASSAKI 2 , Julio Pinheiro BAIMA 2 , José Donizeti de MEIRA JÚNIOR 1 and Luana Moraes CAMPOS 1 to 60%) (10)(11)(12)(13) according to the group. Some factors widely influence the rate of perioperative complications: presence of multidisciplinary team, experience of the surgeon, center of reference to treat IBD, medications in use and duration.…”