Minilaparotomy approach to terminal ileal Crohn’s disease

Abstract

The feasibility and safety of a minilaparotomy approach to terminal ileal Crohn's disease have not been fully elucidated. The purpose of this study was to compare early outcomes utilizing this technique as an alternative to conventional approaches. Nine patients with terminal ileal Crohn's disease (but no complicating enteric fistulas) who underwent minilaparotomy between January 1998 and September 2000 were studied prospectively. The minilaparotomy approach entails a complete surgical procedure performed through a skin incision of less than 7 cm. Ten similar patients who underwent conventional laparotomy between January 1995 and December 1997 served as the control group. Age, gender, body weight, height, body mass index, number of prior laparotomies, operating times, operative blood loss, and types of operative procedure were similar for cases and controls. The length of the laparotomy incision in the minilaparotomy approach group was significantly shorter than that in the conventional approach group (median length 6.0 vs. 16.5 cm; p <0.05). Postoperative intervals until initial standing and walking were significantly shorter for minilaparotomy patients than conventional surgery patients (p <0.05 and p <0.05, respectively), whereas postoperative intervals until passing flatus, urinary catheter removal, and tolerance of liquids and solids did not differ for the two groups, nor did the analgesic requirement or postoperative hospital stay. Postoperative complications developed in two conventional-group patients; none was noted with the minilaparotomy approach. Our data suggest that the minilaparotomy approach to terminal ileal Crohn's disease without an enteric fistula is feasible, safe, and less invasive than the conventional approach.

Strictureplasty

“…Another approach is minilaparotomy and many surgeons use this in preference to a conventional long midline incision. Nakagoe et al 45 reported a series of nine patients with terminal ileal disease, who successfully underwent surgery using minilaparotomy. A minilaparotomy incision is usually less than 7 cm, which is certainly adequate for performing strictureplasty.…”

A randomised controlled trial of transverse skin crease vs. vertical midline incision for right hemicolectomy

“…The advantage of a small incision is the perceived reduction in postoperative pain relief and the subsequently more rapid return of bowel function and hence recovery [10]. Several studies that compared laparoscopic and minilaparotomies colectomies with traditional open procedures have indicated that the shorter recovery may be due to the shorter incision [4][5][6][7][8][9], although this is not always the case [10][11][12].…”

“…Furthermore, it has been claimed that a transverse incision allows access equivalent to the midline incision through a smaller incision [2]. This is important, as evidence from laparoscopic and minilaparotomy studies has suggested that a smaller incision results in less postoperative pain and faster recovery [2][3][4][5][6][7][8][9].…”