Abstract
Background
Outcomes of laparoscopic resection for ileocecal Crohn’s disease have been reported previously in smaller studies, suggesting its short-term advantages over open surgery. This study assessed the safety and recovery parameters in the largest, consecutive, single-institution series to date.
Methods
Consecutive patients undergoing laparoscopically assisted primary ileocolic resection for Crohn’s disease between 1994 and 2006 were identified in an institutional prospectively collected database. Operative and postoperative outcomes at 30 days were studied.
Results
In this study, 109 patients (35 men) with a mean age of 35 ± 14 years and a mean body mass index (BMI) of 25 ± 6 kg/m2 were identified. The main indications for surgery were medically refractory disease (63%) and fibrous stenosis (27%). In 41% of the cases, previous abdominal surgery had been performed. The surgery had a mean duration of 150 ± 45 min and a conversion rate of 6%. The overall 30-day morbidity rate was 11%, and the reoperation rate was 1%. The mortality rate was 0%. The median postoperative hospital stay was 4 days (range, 2–15 days).
Conclusions
This series, the largest reported to date, concurs with recent metaanalyses findings that laparoscopically assisted primary ileocecal resection for Crohn’s disease is safe and feasible, resulting in better short-terms outcomes than open resection. This operation is therefore the procedure of choice for Crohn’s disease at our institutions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bonjer HJ, Hop WC, Nelson H, Sargent DJ, Lacy AM, Castells A, Guillou PJ, Thorpe H, Brown J, Delgado S, Kuhrij E, Haglind E, Pahlman L (2007) Laparoscopically assisted vs open colectomy for colon cancer: a meta-analysis. Arch Surg 142:298–303
Jackson TD, Kaplan GG, Arena G, Page JH, Rogers SOJ (2007) Laparoscopic versus open resection for colorectal cancer: a metaanalysis of oncologic outcomes. J Am Coll Surg 204:439–446
Tjandra JJ, Chan MK (2006) Systematic review on the short-term outcome of laparoscopic resection for colon and rectosigmoid cancer. Colorectal Dis 8:375–388
Milsom JW, Hammerhofer KA, Bohm B, Marcello P, Elson P, Fazio VW (2001) Prospective, randomized trial comparing laparoscopic vs conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum 44:1–8
Maartense S, Dunker MS, Slors JF, Cuesta MA, Pierik EG, Gouma DJ, Hommes DW, Sprangers MA, Bemelman WA (2006) Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg 243:143–149
Tan JJ, Tjandra JJ (2007) Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum 50:576–585
Meagher AP, Wolff BG (1994) Right hemicolectomy with a linear cutting stapler. Dis Colon Rectum 37:1043–1045
Munoz-Juarez M, Yamamoto T, Wolff BG, Keighley MR (2001) Wide-lumen stapled anastomosis vs conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum 44:20–25
Weeks JC, Nelson H, Gelber S, Sargent D, Schroeder G (2002) Short-term quality-of-life outcomes following laparoscopic-assisted colectomy vs open colectomy for colon cancer: a randomized trial. JAMA 287:321–328
Nelson H, Sargent DJ, Wieand S, Fleshman J, Anvari M, Stryker SJ, Beart RW, Hellinger M, Flanagan R, Peters W, Ota D (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059
Wu JS, Birnbaum EH, Kodner IJ, Fry RD, Read TE, Fleshman JW (1997) Laparoscopic-assisted ileocolic resections in patients with Crohn’s disease: are abscesses, phlegmons, or recurrent disease contraindications? Surgery 122:682–688
Young-Fadok TM, HallLong K, McConnell EJ, Gomez Rey G, Cabanela RL (2001) Advantages of laparoscopic resection for ileocolic Crohn’s disease: improved outcomes and reduced costs. Surg Endosc 15:450–454
Alves A, Panis Y, Bouhnik Y, Marceau C, Rouach Y, Lavergne-Slove A, Vicaut E, Valleur P (2005) Factors that predict conversion in 69 consecutive patients undergoing laparoscopic ileocecal resection for Crohn’s disease: a prospective study. Dis Colon Rectum 48:2302–2308
Wilson AP, Gibbons C, Reeves BC, Hodgson B, Liu M, Plummer D, Krukowski ZH, Bruce J, Wilson J, Pearson A (2004) Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients. BMJ 329:720–724
Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA (2006) Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg 93:800–809
Basse L, Jakobsen DH, Bardram L, Billesbolle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241:416–423
Andersen J, Hjort-Jakobsen D, Christiansen PS, Kehlet H (2007) Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery. Br J Surg 94:890–893
Bernell O, Lapidus A, Hellers G (2000) Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease. Br J Surg 87:1697–1701
Gutt CN, Oniu T, Schemmer P, Mehrabi A, Buchler MW (2004) Fewer adhesions induced by laparoscopic surgery? Surg Endosc 18:898–906
Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197:177–181
Acknowledgments
The authors thank Dr. Rui Qin and Ms. Rachel Gullerud at the Division of Biostatistics, Mayo Clinic for their valuable contributions to the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Soop, M., Larson, D.W., Malireddy, K. et al. Safety, feasibility, and short-term outcomes of laparoscopically assisted primary ileocolic resection for Crohn’s disease. Surg Endosc 23, 1876–1881 (2009). https://doi.org/10.1007/s00464-008-0308-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-008-0308-z