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A laparoscopic approach to iterative ileocolonic resection for the recurrence of Crohn’s disease

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Abstract

Background

Laparoscopy is a valuable approach to primary ileocecal resection for ileocolonic Crohn’s disease (CD). This study aimed to evaluate the feasibility of using laparoscopy for reoperation in the case of ileocolonic CD recurrence and to determine the risk factors and consequences of conversion for these patients.

Methods

From 1998 to 2008, 57 patients underwent 62 reoperations for CD recurrence. Of these 62 reoperations, 29 were laparoscopic procedures (laparoscopy group [LG]). Preoperative and intraoperative characteristics and postoperative outcome were compared with those for 33 open procedures (open group [OG]).

Results

The preoperative characteristics were similar in the two groups. The number of intraoperative intestinal injuries was higher in the LG group (n = 5) than in the OG group (n = 0) (p = 0.01). The use of a temporary stoma (7/29 vs. 6/33; nonsignificant difference [NS]) and the mean operating time (215 ± 70 vs. 226 ± 107 min, NS) were similar in the two groups. The postoperative mortality was nil in both groups. The overall morbidity rate was 38% (11/29) in LG and 30% (10/33) in OG (NS). Severe complications (DINDO ≥3) occurred for three of the 29 patients in LG (10%) compared with five of 33 patients in OG (15%) (NS). The median hospital stay was 9 days in both groups. The conversion rate was 31% (9/29). Univariate analysis showed that the risk factors for conversion were fistulizing disease (p = 0.02) and intraoperative intestinal injury (p < 0.001). The morbidity rate was not increased by the need for a conversion (7/20 for the nonconverted vs. 4/9 for the converted patients, NS).

Conclusion

Laparoscopy for ileocolonic CD recurrence is challenging and complex. The morbidity rate was similar to that for the open approach, and the risk of small bowel injury associated with laparoscopy could possibly induce postoperative septic complications. However, the authors believe that laparoscopy can be recommended for selected patients with CD recurrence, especially patients with nonfistulizing disease.

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Disclosure

Drs. A. Brouquet, F. Bretagnol, A. Soprani, P. Valleur, Y. Bouhnik, and Y. Panis have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Beaujon Hospital (APHP), University Paris VII, 100 Boulevard du Général Leclerc, 92118, Clichy Cedex, France

    Antoine Brouquet, Frederic Bretagnol, Antoine Soprani & Yves Panis

  2. Department of Digestive Surgery, Lariboisière Hospital (APHP), 2, Rue Ambroise, Paré, 75475, Paris Cedex 10, France

    Patrice Valleur

  3. Department of Gastroenterology, Beaujon Hospital (APHP), University Paris VII, 100 Boulevard du Général Leclerc, 92118, Clichy Cedex, France

    Yoram Bouhnik

Authors
  1. Antoine Brouquet
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  2. Frederic Bretagnol
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  3. Antoine Soprani
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  4. Patrice Valleur
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  5. Yoram Bouhnik
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  6. Yves Panis
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Correspondence to Yves Panis.

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Brouquet, A., Bretagnol, F., Soprani, A. et al. A laparoscopic approach to iterative ileocolonic resection for the recurrence of Crohn’s disease. Surg Endosc 24, 879–887 (2010). https://doi.org/10.1007/s00464-009-0682-1

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  • DOI: https://doi.org/10.1007/s00464-009-0682-1

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