Laparoscopic resection for Crohn's disease: Safety, feasibility and short-time outcomes

Aims: Laparoscopy is a valuable approach to treat Crohn's disease (CD) surgically. This study was designed to evaluate the results of laparoscopic surgery and to compare to the traditional open technique in the treatment of CD.

Patients/methods: Between 2005 and 2011 study period subjects consisted of 107 patients who had primary surgical treatment for Crohn's disease, 79 through conventional laparotomy and 28 in whom surgery was via laparoscopic approach. Exclusion criteria of laparoscopic surgery were frozen abdomen, recurrent CD following resection and perforated CD. The short-term outcomes and cosmesis were evaluated in both groups. Mann-Whitney U test and Student's t-test were used for statistical analysis.

Results: There were no statistically significant differences between the two groups in the patient characteristics regarding BMI, age, gender, comorbidities, ASA classification. In the open group 18 (22.8%) patients had segmental small intestinal resection, 22 (27.8%) iliocolic resections, 13 (16.4%) right hemicolectomy, 6 (7.6%) subtotal colectomy, 5 (6.3%) colectomy, 7 (8.8%) Hartmann's procedure and 8 (10.1%) combined segmental resection (colon and small intestine). In the laparoscopic group 2 (7.1%) patients had segmental small intestinal resection, 13 (46.4%) iliocolic resections, 6 (21.4%) right hemicolectomy, 6 (21.4%) subtotal colectomy and 1 (3.5%) colectomy. No patients died. Overall postoperative morbidity was similar between both groups [17 percent vs. 15 percent, P=not significant (NS)], including major surgical postoperative complications indicated reoperation (7 percent vs. 6 percent, P=NS). In the laparoscopic group the mean operative time (min) (144±38.2 vs. 126.6±40.3p<0.05), hospital stay (days) (10.89±6.48 vs. 8.8±2.82, p<0.05) and the length of postoperative ileus (days) (2.6±1.3 vs. 1.95±0.9p<0.05) was shorter. Furthermore, the minimal invasive technique resulted better cosmesis and patient satisfaction.

Conclusion: Laparoscopic resection of Crohn's disease is safe, feasible and associated with short-term benefits.