Laparoscopic-assisted surgery for Crohn's disease: reduced surgical stress following ileocolectomy.
Recent progress in laparoscopic techniques has enabled operations for various intestinal disorders to be performed under laparoscopic assistance. This study was conducted to assess the benefits of performing laparoscopic-assisted surgery (LAS) in patients with Crohn's disease. LAS was performed in 24 selected patients with Crohn's disease, most of whom underwent ileocolic resection for ileitis and/or colitis with stenosis. To determine the benefits of LAS, the postoperative inflammatory parameters of these patients were examined and compared with those of 17 patients who underwent conventional open surgery. Despite giving all patients total parenteral nutrition (TPN) for more than 2 weeks preoperatively, two patients with large inflammatory masses involving enteroenteric fistulas required conversion to laparotomy. No laparoscopic procedure was converted for adhesions after previous resection or intraoperative complications. The maximum C-reactive protein values and body temperatures were significantly lower, and the time taken to normalize body temperature and leukocyte counts was significantly shorter in the LAS group than in the laparotomy group. LAS should be performed for patients with Crohn's disease in the inactive phase after appropriate nutritional support. Patients with terminal ileitis without a fistula are considered to have the highest indication for this procedure.
Kishi
D
D
First Department of Surgery, Osaka University Medical School, Suita, Japan.
Nezu
R
R
Ito
T
T
Taniguchi
E
E
Momiyama
T
T
Obunai
S
S
Ohashi
S
S
Matsuda
H
H
D000293:Adolescent; D000328:Adult; D001831:Body Temperature; D002097:C-Reactive Protein / Q000032:analysis; D003082:Colectomy / Q000379:methods*; D003092:Colitis / Q000473:pathology / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007079:Ileitis / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D011183:Postoperative Complications / Q000517:prevention & control
D002097:C-Reactive Protein