title: Laparoscopy for recurrent Crohn's disease: how do the results compare with the results for primary Crohn's disease?
abstract: OBJECTIVE
  To assess the feasibility and outcomes of reoperative laparoscopic-assisted surgery for recurrent Crohn's disease compared with index laparoscopic resections.
  
  
  METHODS
  A retrospective analysis of a prospectively maintained database was performed from 2001 to 2008 on patients who had primary laparoscopy (group I) or reoperative laparoscopy for Crohn's disease (group II). Data collection included demographic and surgical data, and postoperative outcomes.
  
  
  RESULTS
  One hundred and thirty patients were included in this study, distributed as follows: group I, 80 patients with a mean age of 35 years; and group II, 50 patients with a mean age of 42 years. Preoperative American Society of Anesthesiologists score and body mass index were similar in both groups. Patients in group II had a longer period of disease (15.5 vs 8.9 years in groups I and II, respectively; P = 0.0002). Immunosuppressive therapy had been utilized in 66 (82.5%) and in 42 (84%) patients in groups I and II, respectively. Ileocolic resection was the most commonly performed procedure in both groups (82%), followed by subtotal colectomy. Conversion rates were 18.7 and 32% in groups I and II, respectively (P = 0.09). The mean operative time (182 vs 201 min) and mean blood loss (161 vs 202 ml) were not significantly different (P > 0.05); however, the overall incisional length was significantly longer in group II (6.7 vs 11.4 cm, P = 0.045). A stoma was created in 17 and 16% of patients in groups I and II, respectively. Overall, early postoperative complications were not statistically significantly different between the two groups (P > 0.05); anastomotic leak occurred in four (5%) and one (2%) patients (P = 0.65), and abdominal abscess in three (3.75%) and four (8%) patients (P = 0.56), in groups I and II, respectively. Reoperative rates were 10 and 6% (P = 0.53), and mean hospital stay was similar in groups I and II respectively (6.7 vs 7.5 days, respectively; P = 0.3266). There was no mortality.
  
  
  CONCLUSIONS
  The results of laparoscopic-assisted resection for recurrent Crohn's disease are similar to those for primary resection.
authors.affiliation: Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Pinto
authors.forename: S
authors.initials: S
authors.lastname: Shawki
authors.forename: K
authors.initials: K
authors.lastname: Narita
authors.forename: E G
authors.initials: EG
authors.lastname: Weiss
authors.forename: S D
authors.initials: SD
authors.lastname: Wexner
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000328:Adult; D057868:Anastomotic Leak / Q000209:etiology; D003082:Colectomy; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D054047:Surgical Stomas; D016896:Treatment Outcome; D055815:Young Adult