Laparoscopic Surgery for Crohn Disease: A Brief Review of the Literature

Abstract

Crohn disease remains a challenging clinical entity, both medically and surgically. It frequently presents in early adulthood and imposes a lifetime exposure to chronic inflammation that can affect the entire gastrointestinal tract. Although the mainstay of therapy is treatment with immunomodulating drugs, ∼70 to 90% of patients with Crohn disease will ultimately require surgery. Furthermore, there are high rates of symptomatic recurrences that may also require surgical intervention over time. There is no definitive cure for Crohn disease and surgery is reserved for failed medical therapy or the complications of the disease, namely, obstruction, septic complications (abscess, perforation), and fistulas. However, the robust inflammatory environment during these periods is not always conducive to a minimally invasive surgical approach. Despite the inherent technical challenges, the literature has increasingly shown that laparoscopy for Crohn disease, in the appropriate setting, is feasible and safe. In fact, it offers many advantages, which are particularly beneficial to this subset of patients, such as fewer wound complications, a shortened hospital course, less tissue trauma and subsequent adhesion formation, and earlier resumption of oral intake and bowel function.

Keywords

laparoscopy - Crohn disease - minimally invasive surgery

• References

• 1 Loftus Jr EV. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 2004; 126 (6) 1504-1517
• 2 Dasari BV, McKay D, Gardiner K. Laparoscopic versus open surgery for small bowel Crohn's disease. Cochrane Database Syst Rev 2011; (1) CD006956
• 3 Shaffer VO, Wexner SD. Surgical management of Crohn's disease. Langenbecks Arch Surg 2013; 398 (1) 13-27
• 4 Spinelli A, Sacchi M, Bazzi P, Leone N, Danese S, Montorsi M. Laparoscopic surgery for recurrent Crohn's disease. Gastroenterol Res Pract 2012; 2012 (381017) 381017
• 5 Gordon PH, Nivatvongs S. Crohn's disease. In: Principles and Practice of Surgery for the Colon, Rectum, and Anus. 3rd ed. New York, NY: Informa Healthcare; 2007: 820-907
• 6 Holubar SD, Dozois EJ, Privitera A , et al. Laparoscopic surgery for recurrent ileocolic Crohn's disease. Inflamm Bowel Dis 2010; 16 (8) 1382-1386
• 7 Tan JJ, Tjandra JJ. Laparoscopic surgery for Crohn's disease: a meta-analysis. Dis Colon Rectum 2007; 50 (5) 576-585
• 8 Lesperance K, Martin MJ, Lehmann R, Brounts L, Steele SR. National trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches. J Gastrointest Surg 2009; 13 (7) 1251-1259
• 9 Kessler H, Mudter J, Hohenberger W. Recent results of laparoscopic surgery in inflammatory bowel disease. World J Gastroenterol 2011; 17 (9) 1116-1125
• 10 Marcello PW. Laparoscopy for inflammatory bowel disease: pushing the envelope. Clin Colon Rectal Surg 2006; 19 (1) 26-32
• 11 Milsom JW, Hammerhofer KA, Böhm B, Marcello P, Elson P, Fazio VW. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn's disease. Dis Colon Rectum 2001; 44 (1) 1-8 , discussion 8–9
• 12 Maartense S, Dunker MS, Slors JF , et al. Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: a randomized trial. Ann Surg 2006; 243 (2) 143-149 , discussion 150–153
• 13 da Luz Moreira A, Stocchi L, Remzi FH, Geisler D, Hammel J, Fazio VW. Laparoscopic surgery for patients with Crohn's colitis: a case-matched study. J Gastrointest Surg 2007; 11 (11) 1529-1533
• 14 Holubar SD, Dozois EJ, Privitera A, Pemberton JH, Cima RR, Larson DW. Minimally invasive colectomy for Crohn's colitis: a single institution experience. Inflamm Bowel Dis 2010; 16 (11) 1940-1946
• 15 Umanskiy K, Malhotra G, Chase A, Rubin MA, Hurst RD, Fichera A. Laparoscopic colectomy for Crohn's colitis. A large prospective comparative study. J Gastrointest Surg 2010; 14 (4) 658-663
• 16 Chaudhary B, Glancy D, Dixon AR. Laparoscopic surgery for recurrent ileocolic Crohn's disease is as safe and effective as primary resection. Colorectal Dis 2011; 13 (12) 1413-1416
• 17 Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004; 350 (20) 2050-2059
• 18 Bennett CL, Stryker SJ, Ferreira MR, Adams J, Beart Jr RWJ. The learning curve for laparoscopic colorectal surgery. Preliminary results from a prospective analysis of 1194 laparoscopic-assisted colectomies. Arch Surg 1997; 132 (1) 41-44 , discussion 45
• 19 Marcello PW, Fleshman JW, Milsom JW , et al. Hand-assisted laparoscopic vs. laparoscopic colorectal surgery: a multicenter, prospective, randomized trial. Dis Colon Rectum 2008; 51 (6) 818-826 , discussion 826–828
• 20 Nakajima K, Nezu R, Hirota M, Nishida T. The role of hand-assisted laparoscopic surgery in subtotal and total colectomy for Crohn's colitis. Surg Endosc 2010; 24 (11) 2713-2717
• 21 Stewart DB, Messaris E. Early experience with single-site laparoscopic surgery for complicated ileocolic Crohn's disease at a tertiary-referral center. Surg Endosc 2012; 26 (3) 777-782
• 22 Rijcken E, Mennigen R, Argyris I, Senninger N, Bruewer M. Single-incision laparoscopic surgery for ileocolic resection in Crohn's disease. Dis Colon Rectum 2012; 55 (2) 140-146
• 23 Eshuis EJ, Slors JF, Stokkers PC , et al. Long-term outcomes following laparoscopically assisted versus open ileocolic resection for Crohn's disease. Br J Surg 2010; 97 (4) 563-568
• 24 Stocchi L, Milsom JW, Fazio VW. Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: follow-up of a prospective randomized trial. Surgery 2008; 144 (4) 622-627 , discussion 627–628
• 25 Lowney JK, Dietz DW, Birnbaum EH, Kodner IJ, Mutch MG, Fleshman JW. Is there any difference in recurrence rates in laparoscopic ileocolic resection for Crohn's disease compared with conventional surgery? A long-term, follow-up study. Dis Colon Rectum 2006; 49 (1) 58-63