Retrospective Study of Open Versus Laparoscopic Ileocecal Resection in Crohn's Disease in an MIS Era: From a Low-to-Middle Income Country Perspective.

INTRODUCTION

In a mini-invasive surgery (MIS) era, what place holds open surgery for ileocecal resection in Crohn's disease? Our study aims to compare open versus laparoscopic surgery from a low-to-middle income country perspective.

METHODS

This was a retrospective study conducted in a colorectal referral centre in a low-to-middle income country from 2014 to 2020. We included all patients with Crohn's disease admitted in our department for ileocecal resection. Data were collected using chart review. Associations between postoperative complications and covariates were investigated using Pearson's Chi-square analysis, Fisher's exact test for qualitative variables, and t test or Wilcoxon rank sum test for quantitative variables.

RESULTS

We included 83 patients. The median age was 34 (18-75) and 54.2% (n = 45) were female. Open surgery was conducted in 46 cases (55.4%), 30 patients had laparoscopic ileocecal resection (36.1%), and 7 (8.4%) had conversion. When comparing open versus laparoscopic surgery, there was no significant difference in immediate postoperative complications (OR=0.424; 95% CI [0.10-1.66]; P = 0.209, Fisher's = 0.242). Length of stay was significantly different when comparing MIS versus non-MIS (ref(open), β=-2.51;SE=0.93; P = 0.009). When analysing association of covariates with postoperative complications, open surgery was associated with blood transfusion during/after surgery (OR=22.9; 95% CI [2.21-236]; P ≤ 0.001, Fisher's = 0.005), laparoscopic surgery was not (OR=13; 95% CI [0.57-295];P = 0.051, Fisher's0.193).

CONCLUSIONS

Laparoscopic surgery offers a lower risk of operative or postoperative bleeding and a shorter length of stay. It can be safe, effective, and feasible in low- and middle income countries if substantial efforts are made to address all barriers.