Is laparoscopic ileocecal resection a safe option for Crohn's disease? Best evidence topic.
A best evidence topic was constructed according to a structured protocol. The question addressed was whether laparoscopic ileocecal resection for Crohn's disease is associated with higher morbidity rates in comparison to open surgery. From a total of 123 articles, 11 studies provided the best available evidence on this topic. Five observational studies, two randomized trials, three follow up studies and a meta-analysis were identified. The primary author, date and country of publication, study type, patient group characteristics, relevant outcome parameters and results of these papers were tabulated. Perioperative morbidity was either similar between the laparoscopic and the open group, or favored the laparoscopic approach. Convalescence was consistently reported to be shorter in the laparoscopic treatment arm, at cost of longer duration of surgery. Limited evidence suggests lower incidence of small bowel obstruction and disease recurrence for laparoscopy, although follow up data are of poor quality. It may be concluded that laparoscopic ileocecal resection is a safe alternative approach to open surgery for uncomplicated Crohn's disease, provided laparoscopic expertise is available.
Center for Minimally Invasive Surgery, Hospital Neuwerk, Dünner Str. 214-216, 41066 Mönchengladbach, Germany; Department of General Surgery, University General Hospital of Heraklion, Panepistimiou Ave., 71500 Heraklion, Crete, Greece. Electronic address: stavros.antoniou@hotmail.com.
Stavros A
SA
Antoniou
Department of Vascular Surgery, Red Cross Hospital, Athanasaki 1 & Erythrou Stavrou, Ampelokipi, 11526 Athens, Greece.
George A
GA
Antoniou
Department of General and Visceral Surgery, Sisters of Charity Hospital, Seilerstätte 4, 4010 Linz, Austria.
Oliver O
OO
Koch
Department of General and Visceral Surgery, Hospital Zell am See, Paracelsusstr. 8, 5700 Zell am See, Austria.
Rudolph
R
Pointner
Center for Minimally Invasive Surgery, Hospital Neuwerk, Dünner Str. 214-216, 41066 Mönchengladbach, Germany.
Frank A
FA
Granderath
D002432:Cecum / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male
Crohn's disease; Evidence; Ileocecal resection; Laparoscopy; Morbidity