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Single-incision laparoscopic surgery for stricturing and penetrating Crohn’s disease

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Abstract

Purpose

Single-incision laparoscopic surgery (SILS) is a promising new technique that is potentially applicable to Crohn’s disease (CD). However, there is no consensus on the application of SILS for penetrating CD due to its complex pathology.

Methods

We investigated the feasibility of SILS in 24 CD patients (12 with stricturing and 12 with penetrating CD) and compared the results between the two groups.

Results

There were 17 males and seven females [median age at the time of surgery, 41 (range 20–61) years old] included in the study. Sixteen patients underwent primary surgery, while eight received repeat surgery. Twenty patients had small bowel CD and four patients had ileocolonic CD. The indication for surgery was a fistula/abscess in 12 patients, stenosis in 10 and other indications in two cases. The total length of the operation and blood loss was 171 min (113–221 min) and 230 mL (30–400 mL) in the penetrating CD cases, and 149 min (111–186 min) and 90 mL (20–400 mL) in the stricturing CD cases. There were no significant differences in the length of the operation between the two groups, but the blood loss was significantly greater in the cases of penetrating CD. Conversion to open surgery was required in one patient with penetrating CD. Postoperative complications developed in one patient with stricturing CD.

Conclusion

SILS could be performed safely not only in patients with stricturing CD, but also in those with penetrating CD.

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References

  1. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P. Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc. 2012;26:1205–13.

    Article  CAS  PubMed  Google Scholar 

  2. Yamazaki M, Yasuda H, Koda K. Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes. Surg Today. 2014. doi:10.1007/s00595-014-0908-2.

    Google Scholar 

  3. Milsom JW, Hammerhofer KA, Bohm B, Marcello P, Elson P, Fazio VW. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease. Dis Colon Rectum. 2001;44:1–8 (discussion 8–9).

    Article  CAS  PubMed  Google Scholar 

  4. Polle SW, Wind J, Ubbink DT, Hommes DW, Gouma DJ, Bemelman WA. Short-term outcomes after laparoscopic ileocolic resection for Crohn’s disease. A systematic review. Dig Surg. 2006;23:346–57.

    Article  PubMed  Google Scholar 

  5. Rosman AS, Melis M, Fichera A. Metaanalysis of trials comparing laparoscopic and open surgery for Crohn’s disease. Surg Endosc. 2005;19:1549–55.

    Article  CAS  PubMed  Google Scholar 

  6. Tilney HS, Constantinides VA, Heriot AG, Nicolaou M, Athanasiou T, Ziprin P, et al. Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a metaanalysis. Surg Endosc. 2006;20:1036–44.

    Article  CAS  PubMed  Google Scholar 

  7. Bellolio F, Cohen Z, Macrae HM, O’Connor BI, Huang H, Victor JC, et al. Outcomes following surgery for perforating Crohn’s disease. Br J Surg. 2013;100:1344–8.

    Article  CAS  PubMed  Google Scholar 

  8. Rijcken E, Mennigen R, Argyris I, Senninger N, Bruewer M. Single-incision laparoscopic surgery for ileocolic resection in Crohn’s disease. Dis Colon Rectum. 2012;55:140–6.

    Article  PubMed  Google Scholar 

  9. Gardenbroek TJ, Tanis PJ, Buskens CJ, Bemelman WA. Surgery for Crohn’s disease: new developments. Dig Surg. 2012;29:275–80.

    Article  CAS  PubMed  Google Scholar 

  10. Takemasa I, Sekimoto M, Ikeda M, Mizushima T, Yamamoto H, Doki Y, et al. Video. Transumbilical single-incision laparoscopic surgery for sigmoid colon cancer. Surg Endosc. 2010;24:2321.

    Article  PubMed  Google Scholar 

  11. Nakajima K, Nezu R, Hirota M, Nishida T. The role of hand-assisted laparoscopic surgery in subtotal and total colectomy for Crohn’s colitis. Surg Endosc. 2010;24:2713–7.

    Article  PubMed  Google Scholar 

  12. Akiyoshi S, Mimori K, Sudo T, Tanaka F, Shibata K, Mori M. Laparoscopic surgery minimizes the surgical manipulation of isolated tumor cells leading to decreased metastasis compared to open surgery for colorectal cancer. Surg Today. 2013;43:20–5.

    Article  PubMed  Google Scholar 

  13. Clinical Outcomes of Surgical Therapy Study G. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.

    Article  Google Scholar 

  14. Maeda K, Nagahara H, Shibutani M, Otani H, Sakurai K, Toyokawa T, et al. A preoperative low nutritional prognostic index correlates with the incidence of incisional surgical site infections after bowel resection in patients with Crohn’s disease. Surg Today. 2014. doi:10.1007/s00595-014-1044-8.

    Google Scholar 

  15. Stocchi L, Milsom JW, Fazio VW. Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn’s disease: follow-up of a prospective randomized trial. Surgery. 2008;144:622–7.

    Article  PubMed  Google Scholar 

  16. Goyer P, Alves A, Bretagnol F, Bouhnik Y, Valleur P, Panis Y. Impact of complex Crohn’s disease on the outcome of laparoscopic ileocecal resection: a comparative clinical study in 124 patients. Dis Colon Rectum. 2009;52:205–10.

    Article  PubMed  Google Scholar 

  17. Holubar SD, Dozois EJ, Privitera A, Cima RR, Pemberton JH, Young-Fadok T, et al. Laparoscopic surgery for recurrent ileocolic Crohn’s disease. Inflamm Bowel Dis. 2010;16:1382–6.

    Article  PubMed  Google Scholar 

  18. Wu JS, Birnbaum EH, Kodner IJ, Fry RD, Read TE, Fleshman JW. Laparoscopic-assisted ileocolic resections in patients with Crohn’s disease: are abscesses, phlegmons, or recurrent disease contraindications? Surgery. 1997;122:682–8 (discussion 688–689).

    Article  CAS  PubMed  Google Scholar 

  19. Belizon A, Sardinha CT, Sher ME. Converted laparoscopic colectomy: what are the consequences? Surg Endosc. 2006;20:947–51.

    Article  CAS  PubMed  Google Scholar 

  20. Holzheimer RG, Molloy RG, Wittmann DH. Postoperative complications predict recurrence of Crohn’s disease. Eur J Surg. 1995;161:129–35.

    CAS  PubMed  Google Scholar 

  21. Hanauer SB, Sandborn WJ, Rutgeerts P, Fedorak RN, Lukas M, MacIntosh D, et al. Human anti-tumor necrosis factor monoclonal antibody (adalimumab) in Crohn’s disease: the CLASSIC-I trial. Gastroenterology. 2006;130:323–33.

    Article  CAS  PubMed  Google Scholar 

  22. Targan SR, Hanauer SB, van Deventer SJ, Mayer L, Present DH, Braakman T, et al. A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn’s disease. Crohn’s Disease cA2 Study Group. N Engl J Med. 1997;337:1029–35.

    Article  CAS  PubMed  Google Scholar 

  23. Kishi D, Nezu R, Ito T, Taniguchi E, Momiyama T, Obunai S, et al. Laparoscopic-assisted surgery for Crohn’s disease: reduced surgical stress following ileocolectomy. Surg Today. 2000;30:219–22.

    Article  CAS  PubMed  Google Scholar 

  24. Neumann PA, Rijcken EJ, Bruewer M. Current status of laparoscopic surgery for patients with Crohn’s disease. Int J Colorectal Dis. 2013;28:599–610.

    Article  CAS  PubMed  Google Scholar 

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The authors have no conflicts of interest to declare.

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Correspondence to Tsunekazu Mizushima.

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Mizushima, T., Nakajima, K., Takeyama, H. et al. Single-incision laparoscopic surgery for stricturing and penetrating Crohn’s disease. Surg Today 46, 203–208 (2016). https://doi.org/10.1007/s00595-015-1145-z

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  • DOI: https://doi.org/10.1007/s00595-015-1145-z

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