Laparoscopically Assisted Intestinal Resection in 88 Patients with Crohn's Disease

Background: Experience with 94 resections in 88 patients with Crohn's disease using advanced laparoscopic techniques is reported. Records of patients who underwent intestinal resection for Crohn's disease between August, 1993 and November, 1998 were reviewed. Indications, operative findings, clinicopathologic, and postoperative data were recorded.

Methods: In this study, the mean age was 37 years (range, 16-70 years), and 55% of the participants were women. Indications for surgery included obstruction (64 cases), pain (22 cases), peritonitis (1 case) and abscess (1 case). Seventy patients underwent ileocolic resection, 28 of whom had a previous history of one or two ileocolic resections. Eight of these patients had additional procedures including tubal ligation (1), sigmoidectomy (1), cholecystectomy (3 cases), and enterectomy (3 cases). Small bowel resection (13 cases), right hemicolectomy (3 cases), subtotal colectomy (3 cases), anterior rectal resection (2 cases), and sigmoid resection (3 cases) were performed in the remaining patients. All but one procedure were completed laparoscopically with extracorporeal anastomosis. The average length of intestine resected was 33 cm (range, 10-92 cm). Forty-one patients had 58 fistulae between ileum, jejunum, mesentery, colon, abdominal wall, skin, or bladder. Mean blood loss was 168 ml (range, 30-800 ml) and mean operative time was 183 min (range, 96-400 min).

Results: More than 85% of the patients were tolerating a liquid diet on the first postoperative day. Average length of hospital stay was 4.2 days (range, 3-11 days). Complications included anastomotic leak necessitating reoperation, stricture requiring endoscopic dilation, hemorrhage treated expectantly, urinary tract infection, pulmonary embolus, line sepsis, and early postoperative intestinal obstruction (7 cases) requiring reoperation in three cases.

Conclusions: Experience with both advanced laparoscopic techniques and conventional surgery for inflammatory bowel disease allowed successful laparoscopic management of patients with complicated Crohn's disease.