Laparoscopic-assisted bowel resections in inflammatory bowel disease: state of the art.
The objectives of this paper are to review the rational, the present results and future of laparoscopic-assisted bowel surgery in patients with inflammatory bowel disease (IBD). Only a few centres in the world report on laparoscopic bowel resection in IBD that include stoma surgery, ileocolic resection, left, right and (sub)total colectomy for Crohn's disease, and subtotal or restorative total proctocolectomy (ileal pouch anal procedures). The combined series report conversion rates between 2.5% and 22.2%. Ileocolic resection, stoma creation, stricturoplasty and segmental small bowel resection are associated with an acceptable length of surgery, but laparoscopic(-assisted) total colectomy or restorative proctocolectomy still demand up to 4-6 hours of operative time. The few randomised studies addressing laparoscopic-assisted (segmental) bowel surgery versus conventional surgery demonstrated significantly less pain, a quicker return to self-care and a shorter hospital stay. The results of the series reporting on laparoscopic-assisted (ileo)colectomy in IBD are similar to those from these randomised studies. Laparoscopic-assisted subtotal colectomy and restorative proctocolectomy have no benefit compared with conventional surgery other than superior cosmesis. Morbidity of laparoscopic (ileo)colectomy in IBD is low, that of laparoscopic-assisted subtotal colectomy and restorative proctocolectomy remains to be seen. The various laparoscopic bowel resections done in IBD are all feasible. The first series describing laparoscopic surgery for IBD indicate that laparoscopic-assisted segmental (ileo)colectomy is safe and is the preferred approach provided it is done in a centre specialised in the treatment of IBD and by skilled laparoscopic surgeons beyond the learning curve. Until now, laparoscopic-assisted subtotal colectomy and restorative proctocolectomy do not have the same short-term benefits as seen in other laparoscopic colorectal procedures. Patients with inflammatory bowel disease (IBD) have a high life-time risk of having abdominal surgery and reoperations. The proposed advantages of laparoscopic surgery in this group of young patients might be higher than in patients with other colorectal diseases. Minimal physiologic insult in patients who already are under significant physiologic stress, less adhesion formation and superior cosmesis are important benefits over time. In a time where patient's demands will increase, the future of laparoscopic colonic surgery in IBD looks assured.
Bemelman
W A
WA
Department of Gastrointestinal Surgery, Leiden University Medical Center, The Netherlands.
van Hogezand
R A
RA
Meijerink
W J
WJ
Griffioen
G
G
Ringers
J
J
D000714:Anastomosis, Surgical / Q000191:economics / Q000379:methods / Q000592:standards; D003082:Colectomy / Q000191:economics / Q000379:methods / Q000592:standards; D003106:Colon / Q000601:surgery; D003362:Cost-Benefit Analysis; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000191:economics / Q000379:methods / Q000592:standards; D015337:Multicenter Studies as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome