Laparoscopy for Inflammatory Bowel Disease: Pros and Cons

Abstract

The role of laparoscopic surgery in the treatment of colorectal malignancies is still under investigation, although it can offer significant benefits to many patients with inflammatory bowel disease (IBD). The aim of this study was to assess the pros and cons of the laparoscopic management of IBD. Data were obtained from a review of the literature published since 1992, when the first report of laparoscopic surgery for IBD appeared in print. From 1992 to 1997 several series of laparoscopic colorectal surgery for the management of IBD have been reported. A close evaluation of these studies revealed that laparoscopy in patients with terminal ileal Crohn's disease or anal Crohn's disease in need of fecal diversion offers significant advantages compared to laparotomy, including decreased pain, length of hospitalization, and disability. An additional bonus is improved cosmesis and a reduction in symptomatic postoperative adhesions. These many benefits can be achieved without any increase in morbidity or expense. Conversely, the use of this technology for restorative proctocolectomy in patients with mucosal ulcerative colitis is associated with a longer operative time and an increased incidence of both intra- and postoperative complications compared to laparotomy. Laparoscopic colorectal surgery can thus be advantageous for treatment of terminal ileal Crohn's disease but cannot be routinely justified for the treatment of mucosal ulcerative colitis.

Short-Term Outcomes after Laparoscopic Ileocolic Resection for Crohn’s Disease

“…The present systematic review has several important differences from previous reviews[34,35,36,37,38,39,40] and the one other meta-analysis available[ 10]: only studies of acceptable quality, based on a well-defined and transparent quality assessment, were included. This has resulted in the exclusion of two poor quality studies[ 23, 41] from the present meta-analysis.…”

Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial

“…Currently, the superior cosmesis, mentioned frequently [6,[12][13][14], seems to be a permanent advantage of LRP. The importance of cosmesis is substantiated by the increasing number of patients requesting a referral for laparoscopic restorative proctocolectomy to medical centers with expertise in laparoscopic surgery.…”

Chirurgische Therapie des Morbus Crohn

“…Die intraoperative Schnellschnittuntersuchung der Absetzungsra Èn-der besitzt in der Crohn-Chirurgie keinen Stellenwert, da nachgewiesenermaûen die Rezidivha Èufigkeit bei mikroskopisch Crohnbefallenen Absetzungsra È ndern nicht erho È ht ist [19] In den letzten Jahren haben sich die Mitteilungen u È ber laparoskopische Operationsverfahren beim Morbus Crohn geha Èuft. In laparoskopisch erfahrenen Zentren bietet dieses Vorgehen bei der Behandlung eines terminalen Ileum-Crohns wie auch zur Herstellung eines passageren Stomas (Ileostoma) eine Alternative zu konventionellen Operationstechniken [20]. Die Anlage eines Deviationsstomas erfolgt bei ausgepra Ègtem und therapierefrakta Èrem distalem Fistelleiden (perianal, enterogenital) mit Einbeziehung der Sphinktermuskulatur isoliert bzw.…”