Laparoscopically assisted ileo-colonic resection in patients with Crohn's disease--preliminary report.

UNLABELLED: Despite increasing number of reports indicating good treatment outcomes, laparoscopic treatment of Crohn's disease remains controversial. The aim of the study was to compare outcomes of laparoscopically assisted and open ileo-colonic resection in patients with active Crohn's disease.

MATERIAL AND

METHODS

82 patients who underwent surgical treatment (44 laparoscopic and 38 open procedures) at the Department of General, Oncological and Gastrointestinal Surgery in Warsaw were enrolled to the study. The following perioperative parameters were compared in both these groups: duration of hospitalization and presence of postoperative complications in at least 12 months of follow-up.

RESULTS

The conversion rate in the laparoscopy group was 29.5%. There were no statistically significant differences between the study groups with regard to duration of the surgical procedure, requirement for perioperative transfusions and total number of postoperative complications (19.3% in the laparoscopy group versus 28.9% in the open surgery group). However, amount of analgesic drugs required in the postoperative period was significantly lower (25 ± 6 vs 43 ± 9, p < 0.01) and duration of hospitalization was significantly shorter (9.0 vs 11.3 days, p = 0.021) after laparoscopic versus open procedures procedures. Most of the patients with complicated Crohn's disease who were qualified to laparoscopic treatment, underwent successful treatment using this method. Patients in whom conversion was done, were more likely to be on long term preoperative immunosuppressive therapy versus other patients.

CONCLUSIONS

Laparoscopy is a demanding procedure from the technical point of view, but provides valuable benefits to patients with Crohn's disease, including those with a complicated disease. However, this method requires ongoing improvement of technical aspects and thorough analysis of failures to identify factors that could accurately select patients with indications and contraindications to this procedure.