Laparoscopic surgery for recurrent ileocolic Crohn's disease.
BACKGROUND
Laparoscopic (LAP) surgery is increasingly performed for primary ileocolic Crohn's disease (CD), but its application in patients with recurrent ileocolic CD is less well described. Our aim was to assess whether or not a laparoscopic approach was safe, feasible, and conferred meaningful short-term benefits in this patient population.


METHODS
Patients undergoing LAP surgery for recurrent ileocolic CD at our institution from 1998-2008 were identified using a prospectively maintained database. Potential risk factors for conversion to open surgery and overall patient outcomes were assessed with univariate analysis.


RESULTS
Forty patients were identified, of which 30 (75%) were LAP-completed and 10 (25%) were LAP-converted. The groups did not differ with respect to clinicopathological features. LAP-converted patients were significantly more likely to require adhesiolysis than LAP-completed patients (100% versus 67%, P = 0.04). There was 1 intraoperative complication in a converted patient. LAP-converted patients had longer times to soft diet (4 versus 3 days, P = 0.03) and longer length of stay (7 versus 4 days, P = 0.003). The groups did not differ with respect to incidence of postoperative complications or frequency of readmission within 30 days. There was no mortality.


CONCLUSIONS
In up to 20% of patients with recurrent ileocolic, successful laparoscopic re-resection may be prevented by adhesions. Conversion increased the length of stay without increasing morbidity. We conclude that LAP surgery can be safely performed in selected patients with recurrent ileocolic CD and leads to short-term benefits.
Holubar
Stefan D
SD
Division of Colon and Rectal Surgery, Mayo Clinic Rochester, Minnesota, USA.
Dozois
Eric J
EJ
Privitera
Antonio
A
Cima
Robert R
RR
Pemberton
John H
JH
Young-Fadok
Tonia
T
Larson
David W
DW
D000328:Adult; D000368:Aged; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult