This prospective study assessed the feasibility of laparoscopic ileocolonic resection for complex Crohn's disease, i.e., recurrence or complication from abscess and/or fistula, and compared postoperative outcomes in patients with and without complex Crohn's disease.
Between November 1998 and August 2007, 124 laparoscopic ileocolonic resections were attempted for Crohn's disease: 54 patients with complex Crohn's disease (group I) and 70 patients without complex Crohn's disease (group II). Postoperative mortality and morbidity were compared between group I and group II.
Indications for surgery in group I included fistula (43 percent), abscess (30 percent), and recurrent disease after ileocolonic resection (27 percent). Complex Crohn's disease was significantly associated with increased mean (standard deviations) operative time [214 (13) vs. 191(53) minutes, P < 0.05), increased conversion rate to open procedure (37 percent vs. 14 percent, P < 0.01), and increased use of temporary stoma (39 percent vs. 9 percent, P < 0.001). No patients died. Overall postoperative morbidity was similar between both groups [17 percent vs. 17 percent, P = not significant (NS)], including major surgical postoperative complications (7 percent vs. 6 percent, P = NS). Mean (SD) hospital stay was not statistically different between both groups [8 (3) vs. 7 (3) days, P = NS].
This large comparative study suggested that laparoscopic ileocolonic resection for complex Crohn's disease was feasible and safe with good postoperative outcomes. In our experience, complex Crohn's disease does not appear as a contraindication to a laparoscopic approach.
1 Department of Colorectal Surgery, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
2 Department of Gastroenterology, Pôle des Maladies de l'Appareil Digestif, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
3 Department of Digestive Surgery, Lariboisiere Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
Read at the meeting of The American Society of Colon and Rectal Surgeons, Boston, Massachusetts, June 7 to 11, 2008.
Address of correspondence: Yves Panis, M.D., Ph.D., Service de Chirurgie Colorectale (Pôle des Maladies de l'Appareil Digestif, (PMAD)), Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, 100 boulevard du Général Leclerc, 92118 Clichy cedex, France. E-mail: firstname.lastname@example.org