Laparoscopic resection with transcolonic specimen extraction for ileocaecal Crohn's disease.
BACKGROUND
Ileocolic resection for Crohn's disease can be performed entirely laparoscopically. However, an incision is needed for specimen extraction. This prospective observational study assessed the feasibility of endoscopic transcolonic specimen removal.


METHODS
Endoscopic specimen removal was attempted in a consecutive series of ten patients scheduled for laparoscopic ileocolic resection. Primary outcomes were feasibility, operating time, reoperation rate, pain scores, morphine requirement and hospital stay. To assess applicability, outcomes were compared with previous data from patients who had laparoscopically assisted operations.


RESULTS
Transcolonic removal was successful in eight of ten patients; it was considered not feasible in two patients because the inflammatory mass was too large (7-8 cm). Median operating time was 208 min and median postoperative hospital stay was 5 days. After surgery two patients developed an intra-abdominal abscess, drained laparoscopically or percutaneously, and one patient had another site-specific infection. The operation took longer than conventional laparoscopy, with no benefits perceived by patients in terms of cosmesis or body image.


CONCLUSIONS
Transcolonic removal of the specimen in ileocolic Crohn's disease is feasible in the absence of a large inflammatory mass but infection may be a problem. It is unclear whether the technique offers benefit compared with conventional laparoscopic surgery.
Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
E J
EJ
Eshuis
R P
RP
Voermans
P C F
PC
Stokkers
M I
MI
van Berge Henegouwen
P
P
Fockens
W A
WA
Bemelman
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000714:Anastomosis, Surgical; D001828:Body Image; D002432:Cecum / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007079:Ileitis / Q000601:surgery*; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D011788:Quality of Life; D013048:Specimen Handling; D017792:Surgical Stapling; D013536:Suture Techniques; D053706:Typhlitis / Q000601:surgery*; D055815:Young Adult
D000701:Analgesics, Opioid; D009020:Morphine