title: Minimal-invasive approach for penetrating Crohn's disease is not associated with increased complications.
abstract: Laparoscopic surgery for penetrating Crohn's disease (CD) still remains highly conflicting due to a lack of sufficient data. Therefore, the following large study was designed to compare postoperative outcomes after minimal-invasive resections for penetrating and non-penetrating CD.
  
  
  
  Consecutive patients, who underwent laparoscopic intestinal resection for symptomatic CD at a tertiary academic referral center, were included. Patients were divided according to perioperative findings in penetrating and non-penetrating type of disease. All clinical data were obtained from an institutional database and analyzed retrospectively.
  
  
  
  Of 234 patients enrolled, 101 patients [females: n = 54 (53.5 %)] were operated on for non-penetrating CD and 133 patients [females: n = 50 (37.6 %)] for penetrating CD. Fistulas (p < 0.001), inflammatory mass (p < 0.001) and abscess formation (p < 0.001) were observed more frequently in the perforating group. Ileocolic resections were performed predominantly in both groups [perforating CD: n = 110 (82.7 %), non-perforating CD: n = 82 (81.2 %)], with more complex resections (>1 intestinal resection) found in perforating CD (p < 0.001). Conversion rates did not differ significantly. Notably, 30-day postoperative morbidity was comparable for both groups [perforating CD: n = 20 (15 %), non-perforating CD: n = 19 (18.8 %), p = 0.44]. Postoperative complication rates graded according to the Clavien-Dindo classification showed no difference too (p = 0.49).
  
  
  
  Laparoscopic surgery can be conducted safely in selected patients with penetrating CD without increasing the risk of postoperative complications. This finding needs to be implemented in future guidelines.
authors.affiliation: Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Ivan
authors.initials: I
authors.lastname: Kristo
authors.affiliation: Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. anton.stift@meduniwien.ac.at.
authors.forename: Anton
authors.initials: A
authors.lastname: Stift
authors.affiliation: Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Stanislaus
authors.initials: S
authors.lastname: Argeny
authors.affiliation: Center for Medical Statistics, Informatics and Intelligent Systems, Vienna, Austria.
authors.forename: Martina
authors.initials: M
authors.lastname: Mittlböck
authors.affiliation: Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Riss
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D016022:Case-Control Studies; D003082:Colectomy; D003424:Crohn Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Crohn’s disease; Laparoscopic surgery; Non-penetrating Crohn’s disease; Penetrating Crohn’s disease; Perforated Crohn’s disease