[Laparoscopic treatment for Crohn's disease].
OBJECTIVE
Several studies have demonstrated the feasibility and safety of laparoscopic surgery for Crohn's disease. A trend towards less morbidity as compared to laparotomy has been suggested. However, problems noted early in the experience may have prevented the optimal benefit from having been conferred. Accordingly, the aim of this study was to evaluate perioperatively those patients.


METHODS
All 51 patients with Crohn's disease who underwent an intestinal resection at Cleveland Clinic Florida between January 1997 and December 1998 were analyzed.


RESULTS
Seventeen patients underwent laparoscopic treatment: there were no significant differences between the 2 groups as to age, gender, incidences of comorbidity, prior laparotomy, or the use of anti-inflammatory and immunosuppressive agents. Similarly, there were no significant differences between the 2 groups as to either surgical indication, intraoperative findings, or procedure performed. Moreover, there were no significant differences concerning total anesthetic time or surgical operative time, the incidence of intraoperative morbidity or need for enterolysis or stoma construction, use of intraoperative endoscopy, or need for transfusion. Significant differences were noted in the duration of patient controlled analgesic usage (3.1 days in the laparoscopic group vs 3.9 days, respectively; p = 0.03), the incidence of postoperative morbidity (7/17 patients in the laparoscopic group vs 27/34 patients: p = 0.01), and length of hospital stay (6.4 days in the laparoscopic group vs 9.6 days, respectively; p = 0.05).


CONCLUSIONS
In this retrospective cohort comparative study, laparoscopic intestinal resection for Crohn's disease, when compared to laparotomy, was associated with a short duration of patient controlled analgesic usage, a lower incidence of postoperative morbidity and a shorter hospital stay, without significantly increased operative time.
Lauro
A
A
Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale, USA. augustola@yahoo.com
Hamel
C
C
Cirocchi
R
R
Alonso-Poza
A
A
Gervaz
P
P
Doria
C
C
Gruttadauria
S
S
Giustozzi
G
G
Wexner
S D
SD
D000328:Adult; D000367:Age Factors; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000627:therapeutic use; D015331:Cohort Studies; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
D000700:Analgesics