Laparoscopic surgery for complex Crohn's disease

Abstract

In primary Crohn's disease (CD), laparoscopic ileocolic resection has been shown to be both feasible and safe, and is associated with improved outcomes in terms of postoperative morbidity and length of hospital stay. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with complex CD involving localized abscess, fistula or recurrent disease. The aim of this systematic literature review was to assess the feasibility and safety of laparoscopic surgery for complex or recurrent CD. In the current literature, there are nine non-randomized cohort studies, two of which were case-matched. The mean rate of conversion to open laparotomy reported in these series ranged from 7% to 42%. Morbidity rate and hospital stay following laparoscopic resection for complex CD were similar to those for initial resection or for non-complex CD. In summary, even though strong evidence is lacking and more contributions with larger size are needed, the limited experiences available from the literature confirm that the laparoscopic approach for complex CD is both feasible and safe in the hands of experienced IBD surgeons with extensive expertise in laparoscopic surgery. Further studies are required to confirm these results and determine precisely patient selection criteria.

Laparoscopic ileocecal resection in acute and chronic presentations of Crohn�s disease. A single center experience

“…These results confirmed the safety of the procedure (9)(10)(11)(12)(13)(14)(15), so the laparoscopic surgical approach to CD had been fully embraced by our division beside the open one.…”

“…Some reports relate that laparoscopic surgery shows lower morbidity and mortality rates, faster recovery of intestinal motility, lower postoperative admission times, lower adherential syndromes and lower rates of incisional hernias (4,(9)(10)(11)(12)(13)(14)(15).…”

Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease

“…Nevertheless, with a growing number of professionals with expertise in laparoscopic surgery, it is possible to perform laparoscopy even in patients with emergency presentation and recurrent disease. 1 Disease severity was found to be different between the two groups. Patients who underwent open resections were older and had significantly greater disease severity than that of young patients.…”

“…Laparoscopic and open resections are both established therapeutic options with a growing number of planned laparoscopic resections especially in young patients. 1 The goal of any surgery is not to cure the disease but to regain the quality of life of patients undergoing surgery. 2,3 correspondence: Martin hoffmann Department of Surgery, University Medical center Schleswig-holstein, campus lübeck, ratzeburger Allee 160, D-23538 lübeck, germany Tel +49 451 500 40101 Fax +49 451 500 40114 email martin.hoffmann@uksh.de new patients/100,000 inhabitants per year.…”

Laparoscopic surgery for complex and recurrent Crohn’s disease

“…In selected CD patients, laparoscopic surgery is safe, feasible and provides better outcomes compared to open surgery[14-17]. While operative times have decreased with increased experience, operative mortality is almost none and morbidity rates ranged from 10% to 40% in patients undergoing laparoscopic surgery for recurrent CD[17-19]. Postoperative ileus seems as the most common complication which may strongly relate excessive manipulation of the bowel during dissection[13].…”