Minimally invasive colectomy for Crohn's colitis: a single institution experience.
BACKGROUND
Minimally invasive surgery for Crohn's ileocolitis is well established but few data exist regarding laparoscopic techniques for Crohn's colitis. We aimed to describe outcomes associated with minimally invasive surgery for Crohn's colitis, including predictors of conversion to laparotomy and postoperative complications.


METHODS
We identified all Crohn's patients who underwent minimal invasive colectomy at our institution from 1997-2008. Data represent frequency (proportion) or median (interquartile range). Multivariate regression identified factors associated with conversion and 30-day complications (odds ratio [95% confidence interval]).


RESULTS
Over 11 years we identified 92 patients, median age 40 (26-51) years, body mass index (BMI) 22.9 (19.3-26.4) kg/m(2); 61% were women. Median Crohn's duration was 6.5 (4-15) years, 11% had prior intestinal resection; medications included immunomodulators (62%), corticosteroids (54%), infliximab (35%). Forty-three cases (47%) were total colectomy, 17 (18%) subtotal colectomy, 32 (35%) were segmental. Straight laparoscopy was used in 57%; 43% were hand-assisted. Median operative time was 248 (190-292) minutes. There were 15 (16%) conversions; only small bowel disease predicted conversion (OR 7 [1.6-35]). Conversion was not associated with increased length of stay or with postoperative complications. Overall postoperative length of stay was 5 (4-7) days. Short-term complications occurred in 34% with reoperation in 5: obstruction n = 3, anastomotic leak n = 2. Only perianal disease predicted complications (2.6 [1.0-6.6]). There was no 30-day mortality.


CONCLUSIONS
Minimally invasive colectomy in patients with Crohn's colitis can be safely accomplished with reasonable operative times, conversion rates, and excellent postoperative outcomes.
Holubar
Stefan D
SD
Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Dozois
Eric J
EJ
Privitera
Antonio
A
Pemberton
John H
JH
Cima
Robert R
RR
Larson
David W
DW
D000328:Adult; D057868:Anastomotic Leak / Q000453:epidemiology; D015331:Cohort Studies; D003082:Colectomy / Q000379:methods*; D003424:Crohn Disease / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome