title: Laparoscopic-assisted versus conventional ileocolectomy for primary Crohn's disease: results of a comparative study.
abstract: BACKGROUND
  The laparoscopic approach is becoming the gold standard in the surgical treatment of primary Crohn's disease. The aim of this study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease.
  
  
  METHODS
  We conducted a non-randomized, comparative, retrospective analysis of a prospective database from 1998 to 2010. The remaining 129 patients were divided into two groups: laparoscopic-assisted group (Group L; n=64) and conventional group (Group C; n=65). There were no differences between the two groups as regards preoperative patient characteristics. Complications were graded according to the Clavien-Dindo classification.
  
  
  RESULTS
  One hundred and seventeen (90.7%) patients had no complications. Out of 12 patients (9.3%) with complications, four (3.1%) had Grade I, six (4.7%) had Grade II and two (1.6%) had Grade III. There were no postoperative deaths (Grade V). Operating time was longer in Group L compared with Group C (P<0.001). Bowel function returned more quickly in the laparoscopic group in terms of return of bowel movements (P=0.018) and resumption of a regular diet (P=0.06). The mean length of stay was significantly shorter in the laparoscopic group (P=0.001). The mean follow-up was 26 months in Group L versus 34 months in Group C (P=0.06). During follow-up, six patients presented with small bowel obstruction in Group C, which was not statistically different from Group L (3 patients) (P=0.25). During the follow-up period, there have been no recurrences of Crohn's disease in the laparoscopic group while 11 patients (16.9%) have developed a recurrence in the conventional group (P=0.001).
  
  
  CONCLUSIONS
  Laparoscopic-assisted ileocolectomy for primary Crohn's disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn's disease should be considered as the preferred operative approach for primary resections.
authors.affiliation: Department of General Surgery 'A', La Rabta Hospital, Tunis, Tunisia. aminmakni@msn.com
authors.forename: A
authors.initials: A
authors.lastname: Makni
authors.forename: F
authors.initials: F
authors.lastname: Chebbi
authors.forename: R
authors.initials: R
authors.lastname: Ksantini
authors.forename: F
authors.initials: F
authors.lastname: Fétirich
authors.forename: H
authors.initials: H
authors.lastname: Bedioui
authors.forename: M
authors.initials: M
authors.lastname: Jouini
authors.forename: M
authors.initials: M
authors.lastname: Kacem
authors.forename: N
authors.initials: N
authors.lastname: Ben Mami
authors.forename: A
authors.initials: A
authors.lastname: Filali
authors.forename: Z
authors.initials: Z
authors.lastname: Ben Safta
mesh_terms: D000328:Adult; D003082:Colectomy / Q000379:methods*; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D003424:Crohn Disease / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome