Laparoscopic vs conventional ileocolectomy for primary Crohn disease.
OBJECTIVE
Laparoscopic ileocolectomy can reduce the length of hospital stay and hospital charges compared with conventional surgery in the treatment of primary Crohn disease.


METHODS
Nonrandomized, comparative, retrospective analysis of a prospective database.


METHODS
University hospital tertiary care center for inflammatory bowel disease.


METHODS
Forty patients, 20 in the laparoscopic group (group A) and 20 in the conventional group (group B).


METHODS
From July 1, 1996, to June 30, 2001, we collected data on the following demographic clinical end points: age, sex, duration of disease, preoperative medical treatment, previous abdominal surgery, procedure performed, conversions to open surgery, operating time, number of trocars used, size of incision, blood loss, time to resolution of ileus, time to starting solid food diet, duration of hospital stay, hospital charges, morbidity, and mortality.


METHODS
Surgical results, length of hospital stay, hospital charges, and recurrences.


RESULTS
The mean age of the patients was 34.7 years (range, 20-68 years) in group A vs 40.0 years (range, 18-75 years) in group B. The male-female ratio was 1:2 in group A vs 1:1 in group B. The morbidity was 5% in group B. There was no mortality. Operating time was longer in group A (mean, 145.0 minutes; range, 45-270 minutes) compared with group B (mean, 133.5 minutes; range, 98-177 minutes) (P =.36). Blood loss was significantly higher in group B (mean, 265.5 mL; range, 100-400 mL) compared with group A (77.2 mL; range, 25-350 mL) (P<.001). Also, the size of the incision was significantly longer in group B (mean, 13.5 cm; range, 8-18 cm) compared with group A (mean, 5.5 cm; range, 3-12 cm) (P<.001). Bowel function returned more quickly in the laparoscopic group vs the conventional group in terms of return of bowel movements (1.70 vs 2.63 days) (P<.001) and resumption of a regular diet (1.35 vs 2.73 days) (P<.001). The mean length of stay was significantly shorter in the laparoscopic group (4.25 days) vs the conventional group (8.25 days) (P<.001). The mean hospital charges were US $9614 in group A vs US $17 079 in group B (P<.05). The mean follow-up was 17.2 months in group A (range, 2.3-59.9 months) vs 18.7 months in group B (range, 1.0-37.5 months).


CONCLUSIONS
Laparoscopic-assisted ileocolectomy for primary Crohn disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn disease should be considered as the preferred operative approach for primary resections.
Shore
Gregg
G
Department of General Surgery and Colorectal Surgery, University of Alabama, School of Medicine, Birmingham, AL, USA. Gregg.Shore@CCC.UAB.Edu
Gonzalez
Quintin H
QH
Bondora
Anthony
A
Vickers
Selwyn M
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D002432:Cecum / Q000601:surgery; D003082:Colectomy / Q000191:economics / Q000379:methods*; D003424:Crohn Disease / Q000191:economics / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy / Q000191:economics* / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012008:Recurrence; D012189:Retrospective Studies; D014481:United States