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Surgery Insight: minimally invasive surgery for IBD

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages 324–335 (2007)Cite this article

Abstract

The most frequently described laparoscopic operations for the management of patients with IBD are restorative proctocolectomy for ulcerative colitis and ileocolic resection for Crohn's disease. For patients with Crohn's disease, there is level 1b evidence that, in experienced hands, laparoscopic ileocolic resection enhances recovery and leads to a shorter hospital stay compared with conventional ileocolic resection. The demonstrated advantages of laparoscopic ileocolic resection with regard to cost and cosmesis, and the acceptable long-term results achieved (which are at least comparable to those achieved by conventional ileocolic resection) favor the use of laparoscopic ileocolic resection over conventional ileocolic resection in patients with ileocolic Crohn's disease. For patients with ulcerative colitis, the expected advantages of laparoscopic restorative proctocolectomy over conventional restorative proctocolectomy have yet to be clearly shown. Although there is a trend towards a reduced hospital stay (of only 1.6 days) when laparoscopic restorative proctocolectomy is performed, operating times are disproportionably prolonged. The most important argument for offering patients with IBD the chance to undergo a laparoscopic procedure, rather than conventional open surgery, is (particularly for women) the long-term superior cosmesis and body image it confers.

Key Points

  • Technically, virtually all operations performed for the management of IBD can be performed laparoscopically

  • The issue is not whether laparoscopy is feasible in patients with IBD, but whether it is advisable

  • For patients with Crohn's disease, laparoscopic ileocolic resection might be the preferred approach because of its lower morbidity, faster recovery time and improved cosmesis compared with conventional open ileocolic resection

  • For patients with ulcerative colitis, laparoscopic restorative proctocolectomy is characterized by long operating times and higher costs compared with conventional open restorative proctocolectomy; however, the superior cosmesis and preservation of body image justifies using the laparoscopic approach

  • Patients who are less suitable for laparoscopic surgery than open surgery are those who have undergone a prior midline laparotomy, patients with inflammatory masses, and patients who require emergency surgery

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Figure 1: Hand-assisted laparoscopic colectomy
Figure 2: Cosmetic results of laparoscopic surgery for the management of IBD
Figure 3: Exteriorized right colon after laparoscopic mobilization

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  1. and WA Bemelman is Professor of Minimal Invasive Surgery in the Department of Surgery, SW Polle is a Research Fellow, Academic Medical Center, Amsterdam, The Netherlands.,

    Sebastiaan W Polle & Willem A Bemelman

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Correspondence to Willem A Bemelman.

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Polle, S., Bemelman, W. Surgery Insight: minimally invasive surgery for IBD. Nat Rev Gastroenterol Hepatol 4, 324–335 (2007). https://doi.org/10.1038/ncpgasthep0839

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