title: A laparoscopic approach to iterative ileocolonic resection for the recurrence of Crohn's disease.
abstract: BACKGROUND
  Laparoscopy is a valuable approach to primary ileocecal resection for ileocolonic Crohn's disease (CD). This study aimed to evaluate the feasibility of using laparoscopy for reoperation in the case of ileocolonic CD recurrence and to determine the risk factors and consequences of conversion for these patients.
  
  
  METHODS
  From 1998 to 2008, 57 patients underwent 62 reoperations for CD recurrence. Of these 62 reoperations, 29 were laparoscopic procedures (laparoscopy group [LG]). Preoperative and intraoperative characteristics and postoperative outcome were compared with those for 33 open procedures (open group [OG]).
  
  
  RESULTS
  The preoperative characteristics were similar in the two groups. The number of intraoperative intestinal injuries was higher in the LG group (n = 5) than in the OG group (n = 0) (p = 0.01). The use of a temporary stoma (7/29 vs. 6/33; nonsignificant difference [NS]) and the mean operating time (215 + or - 70 vs. 226 + or - 107 min, NS) were similar in the two groups. The postoperative mortality was nil in both groups. The overall morbidity rate was 38% (11/29) in LG and 30% (10/33) in OG (NS). Severe complications (DINDO > or = 3) occurred for three of the 29 patients in LG (10%) compared with five of 33 patients in OG (15%) (NS). The median hospital stay was 9 days in both groups. The conversion rate was 31% (9/29). Univariate analysis showed that the risk factors for conversion were fistulizing disease (p = 0.02) and intraoperative intestinal injury (p < 0.001). The morbidity rate was not increased by the need for a conversion (7/20 for the nonconverted vs. 4/9 for the converted patients, NS).
  
  
  CONCLUSIONS
  Laparoscopy for ileocolonic CD recurrence is challenging and complex. The morbidity rate was similar to that for the open approach, and the risk of small bowel injury associated with laparoscopy could possibly induce postoperative septic complications. However, the authors believe that laparoscopy can be recommended for selected patients with CD recurrence, especially patients with nonfistulizing disease.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital (APHP), University Paris VII, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Brouquet
authors.forename: Frederic
authors.initials: F
authors.lastname: Bretagnol
authors.forename: Antoine
authors.initials: A
authors.lastname: Soprani
authors.forename: Patrice
authors.initials: P
authors.lastname: Valleur
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D003424:Crohn Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D018709:Statistics, Nonparametric; D016896:Treatment Outcome