Abstract
Introduction
The purpose of this study was to compare short-term outcomes of laparoscopic (LC) vs open colectomy (OC) in patients with Crohn’s colitis.
Materials and Methods
We collected data on all patients undergoing colectomy for primary or recurrent Crohn’s disease confined to the colon from July 2002 to August 2008. Patient and disease-specific characteristics and perioperative and short-term postoperative outcomes were prospectively collected and analyzed.
Results
A total of 125 patients underwent colectomy during the study period, 55 (44%) LC. There were six conversions (10.9%). Median operative time was shorter in the LC group (212 min, interquartile range (IQR) 180–315 LC vs 286 min, IQR 231–387 OC, p = 0.032). Estimated blood loss was less for the LC group (100 ml, IQR 90–250 LC vs 250 ml, IQR 100–400 OC, p = 0.002). Earlier return of bowel function was noted in the LC group (3 days vs 4 days, OC). Length of post-op stay was shorter in the LC group (6 days, IQR 5–8 vs 8 days, IQR 6–10 OC, p = 0.001). There was one death in the OC group. Postoperative complications occurred in eight (14.5%) LC patients vs 16 (22.9%) OC. Disease recurrence rate was 16%, 10.9% LC and 20% OC, respectively.
Conclusions
Laparoscopic colectomy is a safe and effective technique in the hands of experienced surgeons. Benefits of laparoscopic colectomy in Crohn’s disease include reduced operative blood loss, quicker return of bowel function, and shorter hospital length of stay.
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References
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):1–8. discussion 8–9
Maartense S, Dunker MS, Slors JF, Cuesta MA, Pierik EG, Gouma DJ, Hommes DW, Sprangers MA, Bemelman WA. Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann Surg 2006;243(2):143–9. discussion 150–153.
Tan JJ, Tjandra JJ. Laparoscopic surgery for Crohn’s disease: a meta-analysis. Dis Colon Rectum 2007;50(5):576–85.
Tilney HS, Constantinides VA, Heriot AG, Nicolaou M, Athanasiou T, Ziprin P, Darzi AW, Tekkis PP. Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a metaanalysis. Surg Endosc 2006;20(7):1036–44.
Rosman AS, Melis M, Fichera A. Metaanalysis of trials comparing laparoscopic and open surgery for Crohn’s disease. Surg Endosc 2005;19(12):1549–1555.
da Luz Moreira A, Stocchi L, Remzi FH, Geisler D, Hammel J, Fazio VW. Laparoscopic surgery for patients with Crohn’s colitis: a case-matched study. J Gastrointest Surg 2007;11(11):1529–1533
Young-Fadok TM, HallLong K, McConnell EJ, Gomez Rey G, Cabanela RL. Advantages of laparoscopic resection for ileocolic Crohn’s disease. Improved outcomes and reduced costs. Surg Endosc 2001;15(5):450–454.
Duepree HJ, Senagore AJ, Delaney CP, Brady KM, Fazio VW. Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum 2002;45(5):605–610.
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(4):682–688. discussion 688–689.
Fichera A, Peng SL, Elisseou NM, Rubin MA, Hurst RD. Laparoscopy or conventional open surgery for patients with ileocolonic Crohn’s disease? A prospective study. Surgery 2007;142(4):566–571. discussion 571.e1.
Laparoscopically assisted colectomy is as safe and effective as open colectomy in people with colon cancer. Abstracted from: Nelson H, sargent D, wieand HS, et al; for the clinical outcomes of surgical therapy study group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050–2059. Cancer Treat Rev 2004;30(8):707–709.
Braga M, Vignali A, Gianotti L, Zuliani W, Radaelli G, Gruarin P, Dellabona P, Di Carlo V. Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 2002;236(6):759–756. discussion 767.
Schwenk W, Bohm B, Haase O, Junghans T, Muller JM. Laparoscopic versus conventional colorectal resection: a prospective randomised study of postoperative ileus and early postoperative feeding. Langenbecks Arch Surg 1998;383(1):49–55.
Lowney JK, Dietz DW, Birnbaum EH, Kodner IJ, Mutch MG, Fleshman JW. Is there any difference in recurrence rates in laparoscopic ileocolic resection for Crohn’s disease compared with conventional surgery? A long-term, follow-up study. Dis Colon Rectum 2006;49(1):58–63.
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(4):622–627. discussion 627–628.
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Poster presented at the 50th Annual Meeting of the Society for Surgery of the Alimentary Tract during Digestive Disease Week.
May 30–June 3, 2009
Chicago, IL
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Umanskiy, K., Malhotra, G., Chase, A. et al. Laparoscopic Colectomy for Crohn’s Colitis. A Large Prospective Comparative Study. J Gastrointest Surg 14, 658–663 (2010). https://doi.org/10.1007/s11605-010-1157-3
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DOI: https://doi.org/10.1007/s11605-010-1157-3