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Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a metaanalysis

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Abstract

Background

The role of laparoscopic surgery for patients with ileocecal Crohn’s disease is a contentious issue. This metaanalysis aimed to compare open resection with laparoscopically assisted resection for ileocecal Crohn’s disease.

Methods

A literature search of the Medline, Ovid, Embase, and Cochrane databases was performed to identify comparative studies reporting outcomes for both laparoscopic and open ileocecal resection. Metaanalytical techniques were applied to identify differences in outcomes between the two groups. Sensitivity analysis was undertaken to evaluate the heterogeneity of the study.

Results

Of 20 studies identified by literature review, 15 satisfied the criteria for inclusion in the study. These included outcomes for 783 patients, 338 (43.2%) of whom had undergone laparoscopic resection, with an overall conversion rate to open surgery of 6.8%. The operative time was significantly longer in the laparoscopic group, by 29.6 min (p = 0.002), although the blood loss and complications in the two groups were similar. In terms of postoperative recovery, the laparoscopic patients had a significantly shorter time for recovery of their enteric function and a shorter hospital stay, by 2.7 days (p < 0.001).

Conclusions

For selected patients with noncomplicated ileocecal Crohn’s disease, laparoscopic resection offered substantial advantages in terms of more rapid resolution of postoperative ileus and shortened hospital stay. There was no increase in complications, as compared with open surgery. The contraindications to laparoscopic approaches for Crohn’s disease remain undefined.

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References

  1. Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, Lai PB, Lau WY (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363: 1187–1192

    Article  PubMed  Google Scholar 

  2. Veldkamp R, Gholghesaei M, Bonjer HJ, Meijer DW, Buunen M, Jeekel J, Anderberg B, Cuesta MA, Cuschierl A, Fingerhut A, Fleshman JW, Guillou PJ, Haglind E, Himpens J, Jacobi CA, Jakimowicz JJ, Koeckerling F, Lacy AM, Lezoche E, Monson JR, Morino M, Neugebauer E, Wexner SD, Whelan RL (2004) Laparoscopic resection of colon cancer: consensus of the European Association of Endoscopic Surgery (EAES). Surg Endosc 18: 1163–1185

    Article  CAS  PubMed  Google Scholar 

  3. Abraham NS, Young JM, Solomon MJ (2004) Meta-analysis of short-term outcomes after laparoscopic resection for colorectal cancer. Br J Surg 91: 1111–1124

    Article  CAS  PubMed  Google Scholar 

  4. Gonzalez R, Smith CD, Mattar SG, Venkatesh KR, Mason E, Duncan T, Wilson R, Miller J, Ramshaw BJ (2004) Laparoscopic vs open resection for the treatment of diverticular disease. Surg Endosc 18: 276–280

    Article  PubMed  CAS  Google Scholar 

  5. Senagore AJ, Duepree HJ, Delaney CP, Brady KM, Fazio VW (2003) Results of a standardized technique and postoperative care plan for laparoscopic sigmoid colectomy: a 30-month experience. Dis Colon Rectum 46: 503–509

    Article  PubMed  Google Scholar 

  6. Milsom JW (2005) Laparoscopic surgery in the treatment of Crohn’s disease. Surg Clin North Am 85: 25–34, vii

    Article  PubMed  Google Scholar 

  7. Bernell O, Lapidus A, Hellers G (2000) Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease. Br J Surg 87: 1697–1701

    Article  CAS  PubMed  Google Scholar 

  8. Msika S, Iannelli A, Deroide G, Jouet P, Soule JC, Kianmanesh R, Perez N, Flamant Y, Fingerhut A, Hay JM (2001) Can laparoscopy reduce hospital stay in the treatment of Crohn’s disease? Dis Colon Rectum 44: 1661–1666

    Article  CAS  PubMed  Google Scholar 

  9. Canin-Endres J, Salky B, Gattorno F, Edye M (1999) Laparoscopically assisted intestinal resection in 88 patients with Crohn’s disease. Surg Endosc 13: 595–599

    Article  PubMed  CAS  Google Scholar 

  10. Bauer JJ, Harris MT, Grumbach NM, Gorfine SR (1995) Laparoscopic-assisted intestinal resection for Crohn’s disease. Dis Colon Rectum 38: 712–715

    Article  PubMed  CAS  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  12. Clarke M, Horton R (2001) Bringing it all together: Lancet-Cochrane collaborate on systematic reviews. Lancet 357: 1728

    Article  CAS  PubMed  Google Scholar 

  13. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 283: 2008–2012

    Article  PubMed  CAS  Google Scholar 

  14. Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748

    CAS  PubMed  Google Scholar 

  15. Sterne JA, Davey Smith G (2001) Sifting the evidence: what’s wrong with significance tests? BMJ 322: 226–231

    Article  CAS  PubMed  Google Scholar 

  16. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7: 177–188

    Article  PubMed  CAS  Google Scholar 

  17. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315: 629–634

    CAS  PubMed  Google Scholar 

  18. Athanasiou T, Al-Ruzzeh S, Kumar P, Crossman MC, Amrani M, Pepper JR, Del Stanbridge R, Casula R, Glenville B (2004) Off-pump myocardial revascularization is associated with less incidence of stroke in elderly patients. Ann Thorac Surg 77: 745–753

    Article  PubMed  Google Scholar 

  19. Egger M, Smith GD (1995) Misleading meta-analysis. BMJ 311: 753–754

    PubMed  CAS  Google Scholar 

  20. Alabaz O, Iroatulam AJ, Nessim A, Weiss EG, Nogueras JJ, Wexner SD (2000) Comparison of laparoscopically assisted and conventional ileocolic resection for Crohn’s disease. Eur J Surg 166: 213–217

    Article  PubMed  CAS  Google Scholar 

  21. Bemelman WA, Slors JF, Dunker MS, van Hogezand RA, van Deventer SJ, Ringers J, Griffioen G, Gouma DJ (2000) Laparoscopic-assisted vs open ileocolic resection for Crohn’s disease: a comparative study. Surg Endosc 14: 721–725

    Article  PubMed  CAS  Google Scholar 

  22. Benoist S, Panis Y, Beaufour A, Bouhnik Y, Matuchansky C, Valleur P (2003) Laparoscopic ileocecal resection in Crohn’s disease: a case-matched comparison with open resection. Surg Endosc 17: 814–818

    Article  PubMed  CAS  Google Scholar 

  23. Bergamaschi R, Pessaux P, Arnaud JP (2003) Comparison of conventional and laparoscopic ileocolic resection for Crohn’s disease. Dis Colon Rectum 46: 1129–1133

    Article  PubMed  Google Scholar 

  24. Diamond IR, Langer JC (2001) Laparoscopic-assisted versus open ileocolic resection for adolescent Crohn disease. J Pediatr Gastroenterol Nutr 33: 543–547

    Article  PubMed  CAS  Google Scholar 

  25. Duepree HJ, Senagore AJ, Delaney CP, Brady KM, Fazio VW (2002) Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum 45: 605–610

    Article  PubMed  Google Scholar 

  26. Dunker MS, Stiggelbout AM, van Hogezand RA, Ringers J, Griffioen G, Bemelman WA (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12: 1334–1340

    Article  PubMed  CAS  Google Scholar 

  27. Dunker MS, Ten Hove T, Bemelman WA, Slors JF, Gouma DJ, Van Deventer SJ (2003) Interleukin-6, C-reactive protein, and expression of human leukocyte antigen-DR on peripheral blood mononuclear cells in patients after laparoscopic vs conventional bowel resection: a randomized study. Dis Colon Rectum 46: 1238–1244

    Article  PubMed  CAS  Google Scholar 

  28. Hong D, Lewis M, Tabet J, Anvari M (2002) Prospective comparison of laparoscopic versus open resection for benign colorectal disease. Surg Laparosc Endosc Percutan Tech 12: 238–242

    Article  PubMed  Google Scholar 

  29. Huilgol RL, Wright CM, Solomon MJ (2004) Laparoscopic versus open ileocolic resection for Crohn’s disease. J Laparoendosc Adv Surg Tech A 14: 61–65

    Article  PubMed  Google Scholar 

  30. Luan X, Gross E (2000) Laparoscopic assisted surgery for Crohn’s disease: an initial experience and results. J Tongji Med Univ 20: 332–335

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  32. Shore G, Gonzalez QH, Bondora A, Vickers SM (2003) Laparoscopic vs conventional ileocolectomy for primary Crohn disease. Arch Surg 138: 76–79

    Article  PubMed  Google Scholar 

  33. Tabet J, Hong D, Kim CW, Wong J, Goodacre R, Anvari M (2001) Laparoscopic versus open bowel resection for Crohn’s disease. Can J Gastroenterol 15: 237–242

    PubMed  CAS  Google Scholar 

  34. von Allmen D, Markowitz JE, York A, Mamula P, Shepanski M, Baldassano R (2003) Laparoscopic-assisted bowel resection offers advantages over open surgery for treatment of segmental Crohn’s disease in children. J Pediatr Surg 38: 963–965

    Article  Google Scholar 

  35. Young-Fadok TM, HallLong K, McConnell EJ, Gomez Rey G, Cabanela RL (2001) Advantages of laparoscopic resection for ileocolic Crohn’s disease: improved outcomes and reduced costs. Surg Endosc 15: 450–454

    Article  PubMed  CAS  Google Scholar 

  36. Kishi D, Nezu R, Ito T, Taniguchi E, Momiyama T, Obunai S, Ohashi S, Matsuda H (2000) Laparoscopic-assisted surgery for Crohn’s disease: reduced surgical stress following ileocolectomy. Surg Today 30: 219–222

    Article  PubMed  CAS  Google Scholar 

  37. Basse L, Hjort Jakobsen D, Billesbolle P, Werner M, Kehlet H (2000) A clinical pathway to accelerate recovery after colonic resection. Ann Surg 232: 51–57

    Article  PubMed  CAS  Google Scholar 

  38. Basse L, Thorbol JE, Lossl K, Kehlet H (2004) Colonic surgery with accelerated rehabilitation or conventional care. Dis Colon Rectum 47: 271–277, discussion 277–278

    Article  PubMed  Google Scholar 

  39. Andersen J, Kehlet H (2005) Fast track open ileocolic resections for Crohn’s disease. Colorectal Dis 7: 394–397

    Article  PubMed  CAS  Google Scholar 

  40. Bardram L, Funch-Jensen P, Kehlet H (2000) Rapid rehabilitation in elderly patients after laparoscopic colonic resection. Br J Surg 87: 1540–1545

    Article  PubMed  CAS  Google Scholar 

  41. Basse L, Jakobsen DH, Bardram L, Billesbolle P, Lund C, Mogensen T, Rosenberg J, Kehlet H (2005) Functional recovery after open versus laparoscopic colonic resection: a randomized, blinded study. Ann Surg 241: 416–423

    Article  PubMed  Google Scholar 

  42. Schmidt CM, Talamini MA, Kaufman HS, Lilliemoe KD, Learn P, Bayless T (2001) Laparoscopic surgery for Crohn’s disease: reasons for conversion. Ann Surg 233: 733–739

    Article  PubMed  CAS  Google Scholar 

  43. Duepree HJ, Senagore AJ, Delaney CP, Fazio VW (2003) Does means of access affect the incidence of small bowel obstruction and ventral hernia after bowel resection? Laparoscopy versus laparotomy. J Am Coll Surg 197: 177–181

    Article  PubMed  Google Scholar 

  44. Lumley J, Stitz R, Stevenson A, Fielding G, Luck A (2002) Laparoscopic colorectal surgery for cancer: intermediate to long-term outcomes. Dis Colon Rectum 45: 867–872, discussion 872–865

    Article  PubMed  Google Scholar 

  45. Krupnick AS, Morris JB (2000) The long-term results of resection and multiple resections in Crohn’s disease. Semin Gastrointest Dis 11: 41–51

    PubMed  CAS  Google Scholar 

  46. Delaney CP, Fazio VW (2001) Crohn’s disease of the small bowel. Surg Clin North Am 81: 137–158, ix

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology and Technology, Imperial College London, St. Mary’s Hospital, 10th Floor QEQM Building, Praed Street, London, W2 1NY, UK

    H. S. Tilney, V. A. Constantinides, A. G. Heriot, M. Nicolaou, T. Athanasiou, P. Ziprin, A. W. Darzi & P. P. Tekkis

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  1. H. S. Tilney
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  2. V. A. Constantinides
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  3. A. G. Heriot
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  5. T. Athanasiou
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Correspondence to P. P. Tekkis.

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Tilney, H.S., Constantinides, V.A., Heriot, A.G. et al. Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a metaanalysis. Surg Endosc 20, 1036–1044 (2006). https://doi.org/10.1007/s00464-005-0500-3

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  • DOI: https://doi.org/10.1007/s00464-005-0500-3

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