Laparoscopic surgery in the management of inflammatory bowel disease.
BACKGROUND
The role of laparoscopic surgery in the treatment of various upper and lower gastrointestinal disorders is still under investigation. However, a variety of laparoscopic procedures may be applied in the treatment of inflammatory bowel disease (IBD).


METHODS
We present our initial results of laparoscopic and laparoscopic-assisted management of IBD in 72 consecutive patients (37 women and 35 men; mean age 36 years, range 20 to 79). The indications for surgery included: terminal ileitis in 29 patients, mucosal ulcerative colitis in 23 patients, Crohn's colitis in 11 patients, severe perianal Crohn's disease in 4 patients, duodenal Crohn's disease in 3 patients, Crohn's rectovaginal fistula in 1 patient, and rectourethral fistula in 1 patient. The procedures performed included: total abdominal colectomy (TAC) in 30 patients (22 with total proctocolectomy with ileoanal reservoir, 6 with TAC with ileorectal anastomosis, and 2 with TAC with end ileostomy), ileocolic resection in 30 patients, diverting loop ileostomy in 6 patients, closure of an end ileostomy as an ileorectal anastomosis in 3 patients who already underwent a TAC with end ileostomy, and duodenal bypass gastrojejunostomy in 3 patients.


RESULTS
There were 16 complications in 13 (18%) patients: 3 enterotomies, 4 episodes of bleeding, 3 pelvic abscesses, 2 intestinal obstructions, 2 prolonged ileus, 1 anastomotic leak, and 1 efferent loop obstruction after gastrojejunostomy. However, only 3 patients required laparotomy for morbidity, and there was no mortality. In 7 (10%) patients, the laparoscopic procedure was converted to a laparotomy due to a large inflammatory mass with fistula in 4 patients, bleeding in 2 patients, and an enterotomy in 1 patient. The mean operating time was 2.9 hours (range 0.7 to 6) and the mean length of hospital stay was 6.5 days (range 3 to 19). When compared with ileocolic resection, total colectomy was associated with higher morbidity (30% versus 10%, P < 0.05) and longer hospitalization (8.7 days [range 4 to 19] versus 5.2 days [range 3 to 7], respectively; P < 0.05).


CONCLUSIONS
According to this initial experience, laparoscopic surgery is a versatile and effective modality in the surgical management of inflammatory bowel disease in selected patients. However, laparoscopic total colectomy is associated with higher morbidity when compared with ileocolic resection.
Reissman
P
P
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Salky
B A
BA
Pfeifer
J
J
Edye
M
M
Jagelman
D G
DG
Wexner
S D
SD
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods; D003093:Colitis, Ulcerative / Q000601:surgery; D003424:Crohn Disease / Q000150:complications / Q000601:surgery; D004378:Duodenal Diseases / Q000601:surgery; D005260:Female; D006801:Humans; D007079:Ileitis / Q000601:surgery; D007081:Ileostomy / Q000379:methods; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative / Q000379:methods; D012003:Rectal Fistula / Q000601:surgery; D012006:Rectovaginal Fistula / Q000601:surgery; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery; D014548:Urinary Fistula / Q000601:surgery