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Open approach for ileocolic resection in Crohn’s disease in the era of minimally invasive surgery: indications and perioperative outcomes in a referral center

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Abstract

Minimally invasive surgery (MIS) is the first-line approach for ileocolic resection in Crohn’s disease (CD), and it is safe and feasible, even with severe penetrating CD or redo surgery. While MIS indications are continually broadening, challenging CD cases might still require an open approach. This study aimed to report rate and indications for an upfront open approach in ileocolic resection for CD. Comprehensive perioperative data for all consecutive patients undergoing ileocolic resection for CD between 2014 and 2021 in a high-volume referral center for CD and MIS, were collected retrospectively. Indications for an upfront open approach were reviewed separately by two authors according to the preoperative visit. Among 319 ileocolic resections for CD, 45 (14%) were open and 274 (86%) MIS. Two or more of the below indications were present in 40 patients (89%) in the open group, while only in 6 patients (2%) in the MIS group (p < 0.0001). Indications for upfront open approach were severe penetrating disease (58%), adhesions at previous surgery (47%), history of abdominal sepsis (33%), multifocal and extensive disease (24%), abdominal wall involvement (22%), concomitant open procedures (9%), small bowel dilatation (9%), and anesthesiologic contraindications (4%). MIS was never performed in a patient with abdominal wall involvement, concomitant open procedure, and anesthesiologic contraindication to MIS. This study can help guide patients, physicians, and surgeons. An abdominal wall involvement or the presence of two of the above indications predicts a high surgical complexity and may be considered as a no-go for the MIS approach. These criteria should prompt surgeons to strongly consider an upfront open approach to optimize the perioperative planning and care of these complex patients.

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Funding

This research did not receive external funding.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN, 55905, USA

    Giacomo Calini, Solafah Abdalla, Mohamed A. Abd El Aziz, Sarah Benammi, Kevin T. Behm, Kellie L. Mathis & David W. Larson

  2. Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, USA

    Amit Merchea

Authors
  1. Giacomo Calini
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  2. Solafah Abdalla
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  3. Mohamed A. Abd El Aziz
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  4. Sarah Benammi
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  5. Amit Merchea
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  6. Kevin T. Behm
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  7. Kellie L. Mathis
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  8. David W. Larson
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Contributions

GC: conception and design of the study, acquisition, analysis, and interpretation of data, drafting the article. SA: conception and design of the study, acquisition of data, and critical revision of the manuscript. MAAEA: design of the study, acquisition and analysis of data, and critical revision of the manuscript. SB: acquisition of data and revision of the manuscript. AM, KTB, and KLM: design of the study, interpretation of data, and critical revision of the manuscript. DWL: conception and design of the study, interpretation of data, and critical revision of the manuscript. All authors approve the present version to be submitted.

Corresponding authors

Correspondence to Giacomo Calini or David W. Larson.

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The authors declare no conflict of interest.

Ethical approval

Ethical approval was waived by the Mayo Clinic’s Institutional Review Board (IRB) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Calini, G., Abdalla, S., Abd El Aziz, M.A. et al. Open approach for ileocolic resection in Crohn’s disease in the era of minimally invasive surgery: indications and perioperative outcomes in a referral center. Updates Surg 75, 1179–1185 (2023). https://doi.org/10.1007/s13304-023-01528-1

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