Surgery Insight: minimally invasive surgery for IBD

Abstract

The most frequently described laparoscopic operations for the management of patients with IBD are restorative proctocolectomy for ulcerative colitis and ileocolic resection for Crohn's disease. For patients with Crohn's disease, there is level 1b evidence that, in experienced hands, laparoscopic ileocolic resection enhances recovery and leads to a shorter hospital stay compared with conventional ileocolic resection. The demonstrated advantages of laparoscopic ileocolic resection with regard to cost and cosmesis, and the acceptable long-term results achieved (which are at least comparable to those achieved by conventional ileocolic resection) favor the use of laparoscopic ileocolic resection over conventional ileocolic resection in patients with ileocolic Crohn's disease. For patients with ulcerative colitis, the expected advantages of laparoscopic restorative proctocolectomy over conventional restorative proctocolectomy have yet to be clearly shown. Although there is a trend towards a reduced hospital stay (of only 1.6 days) when laparoscopic restorative proctocolectomy is performed, operating times are disproportionably prolonged. The most important argument for offering patients with IBD the chance to undergo a laparoscopic procedure, rather than conventional open surgery, is (particularly for women) the long-term superior cosmesis and body image it confers.

Getting Personal

“…3,11,20,27,38–43 Women typically report greater problems with desire/libido, sexual satisfaction, decreased frequency of, and lack of interest in, sexual activity, and fecal incontinence during intercourse. 3,20,27,39 Problems with lubrication, dyspareunia and vaginal infections have also been frequently demonstrated in cross-sectional studies of women who have not had surgery, 17,37 as well as post-operatively in those who have had surgery.…”

“…For example, body image scores tend to be higher in patients following laparoscopic versus open procedures and in non-operated versus operated patients, though these differences are typically found only in women. 3,42,43,49 These gender differences may persistent for many years post-surgery, particularly in patients who undergo open surgery. 43 Conversely, some studies have found no differences in body image or ratings of incision scars among men and women post-surgery.…”

“…3,42,43,49 These gender differences may persistent for many years post-surgery, particularly in patients who undergo open surgery. 43 Conversely, some studies have found no differences in body image or ratings of incision scars among men and women post-surgery. 12,50 …”

Surgery for Crohn’s Disease: New Developments

“…Laparoscopic techniques have transformed colorectal surgery in the last decades, and meanwhile numer-Gardenbroek/Tanis/Buskens/Bemelman ous studies have shown the safety and advantages of laparoscopic surgery in Crohn's disease with reduced hospital stays, shorter times to first postoperative bowel movements, lower complication rates, better cosmetic outcomes and comparable disease recurrence rates for laparoscopic and open surgery [6][7][8][9][10][11][12][13][14]. In our opinion, the laparoscopic approach is preferable in patients with inflammatory bowel disease.…”

Medical management of Crohn’s disease

“…23 Laparoscopic resection is becoming the standard of care (particularly for ileocaecal resection) as time in hospital is 1.6 days shorter than with open surgery, although the operation takes longer and expertise may not be locally available. 24 European guidelines recommend that for contingency planning, surgical options should be discussed with the patient when anti-TNFα therapy is considered.…”