Is There a Role for Laparoscopic Surgery in Recurrent Crohn’s Disease?

Erman Aytac, Fazli C Gezen, David W Dietz, Meagan M Costedio, Luca Stocchi, Emre Gorgun. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Ohio.

 INTRODUCTION: Recurrence of Crohn’s disease after initial resection is a complex condition to manage surgically. The role of laparoscopic technique for treatment of recurrent Crohn`s disease remains unclear. In this study, we aimed to evaluate outcomes of laparoscopic surgery for recurrent Crohn’s disease by comparing it with open surgery in a case-matched setting.

MATERIALS AND METHODS: Patients undergoing elective laparoscopic intestinal resection for recurrent Crohn’s disease between 2003-2012 were case-matched with patients undergoing open surgery based on disease phenotype (penetrating, stricturing, non-stricturing and non-penetrating) and year of surgery. Comparisons of the groups were performed by using χ2 or Fisher exact tests with respect to categorical data and by using the Wilcoxon rank-sum test with respect to quantitative data. Parametric data were reported as means and nonparametric data as numbers.

RESULTS: Forty-eight patients undergoing laparoscopic intestinal resection were matched to 48 counterparts. Age (28 vs. 30 years, p=0.1), American Society of Anesthesiology score (2 vs. 2, p=0.08), gender (F/M; 20/28 vs. 27/21, p=0.15), body mass index (32 vs. 29 kg/m2, p=0.16) and number of previous abdominal operations (1 vs. 1.5, p=0.18) were comparable between the groups. Type of intestinal resection (p=0.67) and intraabdominal findings which were noted during surgical exploration were similar between the groups (table). Six cases (12.5 %) were converted to open surgery and a hand port was used in one case. Operating time (159 vs. 190 min, p=0.31), blood loss (216 vs. 256 ml, p=0.82), postoperative complications, return of bowel function (4 vs. 4, p=0.54), reoperations (2 vs. 1, p=1) and readmissions (8 vs. 4, p=0.22) were comparable between the groups (table). Length of hospital stay was shorter after laparoscopic surgery (6 vs. 10, p=0.004). Postoperative follow-up after surgery for recurrent disease was similar (31 vs. 37 months, p=0.38). During the follow-up period, three patients had surgical re-recurrence in the laparoscopy group, none in the open group (p>0.05).

CONCLUSIONS: Laparoscopic intestinal resection for recurrent Crohn’s disease provides faster recovery without worsening the postoperative outcomes when compared to open surgery. Laparoscopic surgery may safely be offered to patients who had previous resection for Crohn’s disease.

Resection type for recurrent disease, disease phenotype, intraoperative findings, and specific complications
  Laparoscopy
(n=48)
Open
(n=48)
p value
Operation performed, n     0.67
Ileocolectomy 15 13  
Segmental colectomy 4 8  
Colon and small bowel resection 24 22  
Small bowel resection 5 5  
Disease phenotype, n     0.97
Non stricturing, non penetrating 24 25  
Stricturing 14 14  
Penetrating 9 9  
Intraoperative findings, n      
Abdomino-pelvic abscess 2 3 1
Phlegmon 6 9 0.4
Fistula 6 9 0.4
Adhesion 35 35 1
Specific postoperative complications, n      
Ileus 12 10 0.63
Wound infection 2 6 0.14
Abdomino-pelvic abscess 1 2 1
Anastomotic leak 1 2 1
Bleeding 1 1 1
Fistula 0 2 0.5
Dehydration 1 1 1
Urinary tract infection 1 1 1
Acute renal failure 0 1 0.32

 

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