Laparoscopy or conventional open surgery for patients with ileocolonic Crohn's disease? A prospective study.
BACKGROUND
Crohn's patients have been considered challenging laparoscopic candidates. The aim of this study was to analyze the short-term and long-term outcomes of laparoscopic and open surgery in consecutive patients with ileocolonic Crohn's disease.


METHODS
Patients were enrolled prospectively but not randomized between August 2002 and October 2006. Patients and disease-specific characteristics, intraoperative variables, and short-term and long-term postoperative outcomes were analyzed.


RESULTS
Overall, 146 consecutive patients were included in the study: 59 in the laparoscopic operation group and 87 in the open operation group. Laparoscopic patients were younger (P = .001), with a lower body mass index (BMI) (P = .008). Operative time was similar between the 2 groups. Blood loss was less in the laparoscopic group (P = .012), and postoperative blood transfusions were administered only to patients in the open group. Narcotic requirement, which was expressed as days on the IV narcotics and as morphine equivalent, was less in the laparoscopic group (P = .01). Duration of stay was less in the laparoscopic group, 5.5 versus 7.0 days, (P = .001). Using step-wise multiple regression analysis, the use of laparoscopic operation was associated with a lesser hospital stay (P < .05). Complication rates were similar, which included 1 anastomotic leak that required reoperation in each group. At a median follow-up of 19 months, there have been no disease recurrences.


CONCLUSIONS
In selected patients, laparoscopy leads to a faster recovery without increasing morbidity and without compromising remission. It should be considered a safe and effective alternative to open operation.
Fichera
Alessandro
A
Department of Surgery, University of Chicago, Chicago, Illinois 60637, USA. afichera@surgery.bsd.uchicago.edu
Peng
Stephanie L
SL
Elisseou
Nicholas M
NM
Rubin
Michele A
MA
Hurst
Roger D
RD
D000293:Adolescent; D000328:Adult; D000368:Aged; D003108:Colonic Diseases / Q000453:epidemiology / Q000601:surgery; D003424:Crohn Disease / Q000453:epidemiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000453:epidemiology / Q000601:surgery; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome