Advertisement

Surgical Endoscopy

, Volume 30, Issue 1, pp 99–105 | Cite as

Short- and long-term outcomes of laparoscopic surgery for intestinal Behcet’s disease: a comparative study with open surgery

  • Se Jin BaekEmail author
  • Seung Hyuk Baik
  • Chang Woo Kim
  • Min Soo Cho
  • Hyun A. Jang
  • Hyuk Hur
  • Byung Soh Min
  • Nam Kyu Kim
Article

Abstract

Introduction

Surgical treatment of intestinal Behcet’s disease (BD) is not well established. Specifically, it is still difficult to assess the clinical value of laparoscopic surgery to address this condition. We aimed to evaluate the clinical course and the characteristics of laparoscopic surgery for intestinal BD compared with open surgery.

Methods

We reviewed charts of 91 patients who underwent surgical treatment for intestinal BD between January 1995 and December 2012. We retrospectively compared the laparoscopic group (LG, n = 30) and the open group (OG, n = 61) in terms of patient demographics, clinical features, operative data, postoperative course, complications within 30 days after operation, and long-term follow-up data.

Results

There were more females in the LG than in the OG (63.3 vs. 36.1 %, p = 0.014), and oral/genital ulcers were more frequent in the LG (76.7 vs. 54.1 %, p = 0.038; 60 vs. 36.1 %, p = 0.031). Intractability with medical treatment was dominant in the LG (76.7 vs. 45.9 %, p = 0.02), while intestinal perforation or fistula were more prevalent in the OG (10 vs. 44.3 %, p = 0.001). Most patients received an ileocecectomy or a right hemicolectomy as their first surgery. In the LG, the patients had a shorter operation time (162.0 vs. 228.5 min, p < 0.001) and had less blood loss (61.7 vs. 232.3 ml, p = 0.003). There were no significant differences in postoperative complications, reoperation, mortality, and hospital stay between the groups. During the follow-up period, the mean number of operations was less in the LG than in the OG (1.3 vs. 2.1, p = 0.011). Analysis indicated that 20 % of patients in the LG and 50.8 % in the OG underwent more than two operations (p = 0.005).

Conclusion

Laparoscopic surgery is feasible and safe for selected intestinal BD patients. However, there were no better short-term outcomes in LG compared with OG.

Keywords

Intestinal Behcet’s disease Surgery Laparoscopy 

Notes

Acknowledgments

The authors would also like to thank MiSun Park (professional editor) for her English correction of the manuscript.

Disclosures

The authors have no actual or potential personal, political, or financial conflicts of interest with regards to this study.

References

  1. 1.
    Kobayashi K, Ueno F, Bito S, Iwao Y, Fukushima T, Hiwatashi N, Igarashi M, Iizuka BE, Matsuda T, Matsui T, Matsumoto T, Sugita A, Takeno M, Hibi T (2007) Development of consensus statements for the diagnosis and management of intestinal Behcet’s disease using a modified Delphi approach. J Gastroenterol 42:737–745PubMedCrossRefGoogle Scholar
  2. 2.
    Sakane T, Takeno M, Suzuki N, Inaba G (1999) Behcet’s disease. N Engl J Med 341:1284–1291PubMedCrossRefGoogle Scholar
  3. 3.
    Chang HK, Kim JW (2002) The clinical features of Behcet’s disease in Yongdong districts: analysis of a cohort followed from 1997 to 2001. J Korean Med Sci 17:784–789PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Bang D, Yoon KH, Chung HG, Choi EH, Lee ES, Lee S (1997) Epidemiological and clinical features of Behcet’s disease in Korea. Yonsei Med J 38:428–436PubMedCrossRefGoogle Scholar
  5. 5.
    Shimizu T, Ehrlich GE, Inaba G, Hayashi K (1979) Behcet disease (Behcet syndrome). Semin Arthritis Rheum 8:223–260PubMedCrossRefGoogle Scholar
  6. 6.
    Cheon JH, Kim ES, Shin SJ, Kim TI, Lee KM, Kim SW, Kim JS, Kim YS, Choi CH, Ye BD, Yang SK, Choi EH, Kim WH (2009) Development and validation of novel diagnostic criteria for intestinal Behcet’s disease in Korean patients with ileocolonic ulcers. Am J Gastroenterol 104:2492–2499PubMedCrossRefGoogle Scholar
  7. 7.
    Iida M, Kobayashi H, Matsumoto T, Okada M, Fuchigami T, Yao T, Fujishima M (1994) Postoperative recurrence in patients with intestinal Behcet’s disease. Dis Colon Rectum 37:16–21PubMedCrossRefGoogle Scholar
  8. 8.
    Ebert EC (2009) Gastrointestinal manifestations of Behcet’s disease. Dig Dis Sci 54:201–207PubMedCrossRefGoogle Scholar
  9. 9.
    Smith JA, Siddiqui D (2002) Intestinal Behcet’s disease presenting as a massive acute lower gastrointestinal bleed. Dig Dis Sci 47:517–521PubMedCrossRefGoogle Scholar
  10. 10.
    Masugi J, Matsui T, Fujimori T, Maeda S (1994) A case of Behcet’s disease with multiple longitudinal ulcers all over the colon. Am J Gastroenterol 89:778–780PubMedGoogle Scholar
  11. 11.
    Kasahara Y, Tanaka S, Nishino M, Umemura H, Shiraha S, Kuyama T (1981) Intestinal involvement in Behcet’s disease: review of 136 surgical cases in the Japanese literature. Dis Colon Rectum 24:103–106PubMedCrossRefGoogle Scholar
  12. 12.
    Larson DW, Davies MM, Dozois EJ, Cima RR, Piotrowicz K, Anderson K, Barnes SA, Harmsen WS, Young-Fadok TM, Wolff BG, Pemberton JH (2008) Sexual function, body image, and quality of life after laparoscopic and open ileal pouch-anal anastomosis. Dis Colon Rectum 51:392–396PubMedCrossRefGoogle Scholar
  13. 13.
    Polle SW, Dunker MS, Slors JF, Sprangers MA, Cuesta MA, Gouma DJ, Bemelman WA (2007) Body image, cosmesis, quality of life, and functional outcome of hand-assisted laparoscopic versus open restorative proctocolectomy: long-term results of a randomized trial. Surg Endosc 21:1301–1307PubMedCrossRefGoogle Scholar
  14. 14.
    Larson DW, Cima RR, Dozois EJ, Davies M, Piotrowicz K, Barnes SA, Wolff B, Pemberton J (2006) Safety, feasibility, and short-term outcomes of laparoscopic ileal-pouch-anal anastomosis: a single institutional case-matched experience. Ann Surg 243:667–670; discussion 670–662Google Scholar
  15. 15.
    Larson DW, Dozois EJ, Piotrowicz K, Cima RR, Wolff BG, Young-Fadok TM (2005) Laparoscopic-assisted vs. open ileal pouch-anal anastomosis: functional outcome in a case-matched series. Dis Colon Rectum 48:1845–1850PubMedCrossRefGoogle Scholar
  16. 16.
    Kienle P, Z’Graggen K, Schmidt J, Benner A, Weitz J, Büchler MW (2005) Laparoscopic restorative proctocolectomy. Br J Surg 92:88–93PubMedCrossRefGoogle Scholar
  17. 17.
    Tan JJ, Tjandra JJ (2007) Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum 50:576–585PubMedCrossRefGoogle Scholar
  18. 18.
    Wexner SD, Johansen OB, Nogueras JJ, Jagelman DG (1992) Laparoscopic total abdominal colectomy. A prospective trial. Dis Colon Rectum 35:651–655PubMedCrossRefGoogle Scholar
  19. 19.
    Schmitt SL, Cohen SM, Wexner SD, Noqueras JJ, Jagelman DG (1994) Does laparoscopic-assisted ileal pouch anal anastomosis reduce the length of hospitalization? Int J Colorectal Dis 9:134–137PubMedCrossRefGoogle Scholar
  20. 20.
    Reissman P, Salky BA, Pfeifer J, Edy M, Jagelman DG, Wexner SD (1996) Laparoscopic surgery in the management of inflammatory bowel disease. Am J Surg 171:47–50; discussion 50–41Google Scholar
  21. 21.
    Larson DW, Pemberton JH (2004) Current concepts and controversies in surgery for IBD. Gastroenterology 126:1611–1619PubMedCrossRefGoogle Scholar
  22. 22.
    Marcello PW, Milsom JW, Wong SK, Hammerhofer KA, Goormastic M, Church JM, Fazio VW (2000) Laparoscopic restorative proctocolectomy: case-matched comparative study with open restorative proctocolectomy. Dis Colon Rectum 43:604–608PubMedCrossRefGoogle Scholar
  23. 23.
    Hashimoto A, Funayama Y, Naito H, Fukushima K, Shibata C, Naitoh T, Shibuya K, Koyama K, Takahashi K, Ogawa H, Satoh S, Ueno T, Kitayama T, Matsuno S, Sasaki I (2001) Laparoscope-assisted versus conventional restorative proctocolectomy with rectal mucosectomy. Surg Today 31:210–214PubMedCrossRefGoogle Scholar
  24. 24.
    Dasari BV, McKay D, Gardiner K (2011) Laparoscopic versus Open surgery for small bowel Crohn’s disease. Cochrane Database Syst Rev 2011(1):CD006956Google Scholar
  25. 25.
    Naganuma M, Iwao Y, Inoue N, Hisamatsu T, Imaeda H, Ishii H, Kanai T, Watanabe M, Hibi T (2000) Analysis of clinical course and long-term prognosis of surgical and nonsurgical patients with intestinal Behcet’s disease. Am J Gastroenterol 95:2848–2851PubMedGoogle Scholar
  26. 26.
    Jung YS, Hong SP, Kim TI, Kim WH, Cheon JH (2012) Early versus late surgery in patients with intestinal Behcet disease. Dis Colon Rectum 55:65–71PubMedCrossRefGoogle Scholar
  27. 27.
    Jung YS, Yoon JY, Lee JH, Jeon SM, Hong SP, Kim TI, Kim WH, Cheon JH (2011) Prognostic factors and long-term clinical outcomes for surgical patients with intestinal Behcet’s disease. Inflamm Bowel Dis 17:1594–1602PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Se Jin Baek
    • 1
    Email author
  • Seung Hyuk Baik
    • 1
  • Chang Woo Kim
    • 1
  • Min Soo Cho
    • 1
  • Hyun A. Jang
    • 1
  • Hyuk Hur
    • 1
  • Byung Soh Min
    • 1
  • Nam Kyu Kim
    • 1
  1. 1.Section of Colorectal Surgery, Department of Surgery, Severance HospitalYonsei University College of MedicineSeoulSouth Korea

Personalised recommendations