Laparoscopically Assisted Ileo-Colonic Resection in Patients with Crohn’s Disease – Preliminary Report

• Authors: Katarzyna Borycka-Kiciak , Naser Dib , Łukasz Janaszek , Łukasz Sołtysiak , Barbara Bukowicka , Wiesław Tarnowski
• Languages of publication: EN

Abstracts

EN

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.

Keywords

EN

laparoscopy; Crohn’s disease; postoperative complications

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2013
• Volume: 85
• Issue: 9
• Pages: 505-510

Dates

published

1 - 09 - 2013

online

15 - 10 - 2013

Contributors

author

Katarzyna Borycka-Kiciak

• Department of General, Oncological and Gastrointestinal Surgery, Orłowski Hospital MCPE in Warsaw Kierownik: prof. dr hab. W. Tarnowski

author

Naser Dib

• Department of General, Oncological and Gastrointestinal Surgery, Orłowski Hospital MCPE in Warsaw Kierownik: prof. dr hab. W. Tarnowski

author

Łukasz Janaszek

• Department of General, Oncological and Gastrointestinal Surgery, Orłowski Hospital MCPE in Warsaw Kierownik: prof. dr hab. W. Tarnowski

author

Łukasz Sołtysiak

• Department of General, Oncological and Gastrointestinal Surgery, Orłowski Hospital MCPE in Warsaw Kierownik: prof. dr hab. W. Tarnowski

author

Barbara Bukowicka

• Department of General, Oncological and Gastrointestinal Surgery, Orłowski Hospital MCPE in Warsaw Kierownik: prof. dr hab. W. Tarnowski

author

Wiesław Tarnowski

• Department of General, Oncological and Gastrointestinal Surgery, Orłowski Hospital MCPE in Warsaw Kierownik: prof. dr hab. W. Tarnowski

References

• 1.Bemelman WA , Slors JF, Dunker MS, van HogezandRA et al.: Laparoscopic-assisted vs. open ileocolic resection for Crohn’s disease. A comparative study. Surg Endosc 2000; 14: 721-25.[Crossref][PubMed]
• 2. Bemelman WA , Dunker MS, Slors JF et al.: Laparoscopic surgery for inflammatory bowel disease: current concepts. Scand J Gastroenterol Suppl 2002; 37: 54-59.[Crossref]
• 3. Gurland BH, Wexner SD: Laparoscopic surgery for inflammatory bowel disease: results of the past decade. Inflamm Bowel Dis 2002; 8: 46-54.[Crossref][PubMed]
• 4. Maartense S, Dunker MS, Slors JF et al.: Laparoscopic- assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg 2006; 243: 143-49; discussion 150-53.[Crossref]
• 5. Tilney HS, Constantinides VA, Heriot AG et al.: Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a meta-analysis. SurgEndosc 2006; 20: 1036-44.
• 6. Tan L, Tjandra JJ: Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum 2007; 50: 576-85.[PubMed][Crossref]
• 7. Ananthakrishnan AN , McGinney EL, Saeian K et al.:Laparoscopic resection for Inflammatory Bowel Disease: outcomes from a nationwide sample. J Gastrointest Surg 2010; 14: 58-65.[Crossref][WoS][PubMed]
• 8. Polle SW , Wind J, Ubbink DT et al.: Short-term outcomes after laparoscopic ileocolic resection for Crohn’s disease. A systematic review. Dig Surg 2006; 23(5-6): 346-57.[Crossref][PubMed]
• 9. Milsom JW, Hammerhofer KA , Böhm B et al.: Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum 2001; 44: 1-9.[Crossref]
• 10. Milsom JW: Laparoscopic surgery in the treatment of Crohn’s disease. Surg Clin North Am 2005; 85: 25-34.[PubMed][Crossref]
• 11. Alves A, Panis Y, Bouhnik Y et al.: Factors that predict conversion in 69 consecutive patients undergoing laparoscopic ileocecal resection for Crohn’s disease: a prospective study. Dis Colon Rectum 2005; 48: 2302-08.[Crossref]
• 12. Meijerink WJ, Eijsbouts QA, Cuesta MA et al.: Laparoscopically assisted bowel surgery for inflammatory bowel disease. The combined experience of two academic centers. Surg Endosc 1999; 13: 882-86.[Crossref]
• 13. Myrelid P, Olaison G, Sjodahl R et al.: Thiopurine therapy is associated with postoperative intraabdominal septic complications in abdominal surgery for Crohn’s disease. Dis Colon Rectum 2009; 52: 1387-94.[WoS][Crossref]
• 14. White EC, Melmed GY, Vasiliauskas E et al.: Does preoperative immunosuppression influence unplanned hospital readmission after surgery in patients with Crohn’s disease? Dis Colon Rectum 2012; 55: 563-68.[WoS][Crossref][PubMed]
• 15. Diamond IR , Gerstle JT, Kim PC et al.: Outcomes after laparoscopic surgery in children with inflammatory bowel disease. Surg Endosc 2010; 24: 2796-2802.[PubMed][Crossref][WoS]
• 16. Talamini MA, Moesinger RC, Kaufman H et al.: Laparoscopically assisted bowel resection for Crohn’s disease. Digestive Disease Week 1997. Abstract Book.
• 17. Riss S, Bittermann C, Schwameis K et al.: Determinants for postoperative complications after laparoscopic intestinal resection for Crohn’s disease. Surg Endosc 2012; 26(4): 933-38.[Crossref][PubMed][WoS]
• 18. Pinto RA , Shawki S, Narita K et al.: Laparoscopy for recurrent Crohn’s disease: how do the results compare with the results for primary Crohn’s disease? Colorectal Dis 2011; 13: 302-07.[Crossref][PubMed]
• 19. Chaudhary B, Glancy D, Dixon AR : Laparoscopic surgery for recurrent ileocolic Crohn’s disease is as safe and effective as primary resection. ColorectalDis 2011; 13: 1413-16.[WoS][Crossref]
• 20. Huang R, Valerian BT , Lee EC: Laparoscopic approach in patients with reccurent Crohn’s disease. Am Surg 2012; 78: 595-99.
• 21. Beyer-Berjot L, Mancini J, Bege T et al.: Laparoscopic approach is feasible in Crohn’s complex enterovisceral fistulas: a case-match review. DisColon Rectum 2013; 56: 191-97.
• 22. Edden Y, Ciardullo J, Sherafgan K et al.: Laparoscopic- assisted ileocolic resection for Crohn’s disease. JSLS 2008; 12: 139-42.[PubMed]
• 23. Holubar SD, Dozois EJ, Privitera A et al.: Laparoscopic surgery for recurrent ileocolic Crohn’s disease. Inflamm Bowel Dis 2010; 16(8): 1382-86.[Crossref][PubMed][WoS]

Identifiers

DOI

10.2478/pjs-2013-0078