Laparoscopically assisted hemicolectomy for Crohn's disease: are we still getting better?
The most common indications for laparoscopic surgery in Crohn's disease include ileocolic resection and right hemicolectomy. The aim of this study was to compare the results of right hemicolectomy in an early phase versus a later phase. Between August 1992 and October 1998 all patients who underwent laparoscopic surgery for ileocolic resection and right hemicolectomy were divided into chronological groups: Group I = August 1992 to January 1996 and Group II = February 1996 to October 1998. Statistical analysis was performed using the Mann-Whitney test, Student t test, or Fisher's exact test. We identified 41 patients; 16 patients [eight females and eight males with an average age of 37.1 (range 20-59) years] were in Group I and 25 [16 females and nine males with an average age of 41.9 (range 15-74) years] were in Group II [P = not significant (NS)]. Overall there were five (12%) intraoperative complications reported: two (12%) in Group I and three (12%) in Group II (P = NS). Mean operative time was 149 (range 90-260) minutes in Group I versus 158 (range 100-285) minutes in Group II (P = NS). Mean length of hospital stay was 7.4 (range 4-18) days in Group I and 6.6 (range 3-20) days in Group II (P = NS). Four patients (25%) in Group I and seven (28%) in Group II had their procedures converted to laparotomy (P = NS). In Group I four (25%) patients had surgery-related postoperative complications, one of which was wound related. One patient has an anastomotic leak whereas two had prolonged postoperative ileus. In Group II six (24%) patients had surgery-related complications, two of which were wound related, three were cases of prolonged postoperative ileus, and one was an anastomotic leak (P = NS between Groups I and II). Perhaps as a result of the relative technical ease of right-sided resections or the nature of the disease the expected decrease in morbidity and conversion rate over time could not be shown.
Hamel
Christian T
CT
Department of Colorectal Surgery, Cleveland Clinic Florida, Weston 33331, USA.
Pikarsky
Alon J
AJ
Wexner
Steven D
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence; D003082:Colectomy / Q000379:methods*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome