Laparoscopic surgery in inflammatory bowel disease: is the future already here?
OBJECTIVE
Starting from easy operations like the creation of enterostomies, laparoscopic colorectal surgery has developed quickly towards comprehensive procedures like proctocolectomies. Because of their benign character, inflammatory bowel diseases are an ideal indication for laparoscopic surgical approaches. Inflammatory alterations of bowel and mesentery, however, may demand a high level of laparoscopic experience.


RESULTS
In severe anal Crohn's disease, laparoscopic stoma formation has become a standard procedure for low morbidity and reoperation rates. In comparison with conventional bowel resections for Crohn's disease, shorter times to first postoperative bowel movements and hospital stays have been observed with the laparoscopic approach. Even complex cases with previous surgery and enteric fistulas may be managed laparoscopically with a low complication rate. In ulcerative colitis, experience with laparoscopic restorative proctocolectomy is increasing, and its feasibility has been proven in multiple studies. An elevated risk of complications has been observed with increased body mass index and acute inflammation. Function and quality of life outcomes seem to be equivalent for open and laparoscopic surgery.


CONCLUSIONS
Laparoscopic management of Crohn's disease and ulcerative colitis is complex and may be demanding. Its feasibility has been proven in multiple studies and it is offered as a safe and durable alternative for selected patients. The selection criteria are under investigation.
Kessler
Hermann
H
Department of Surgery, University of Erlangen-Nürnberg, Erlangen, Germany. kessleh@aol.com
D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000639:trends*; D016896:Treatment Outcome