title: Laparoscopic ileocecal resection in acute and chronic presentations of Crohn's disease. A single center experience.
abstract: BACKGROUND
  The terminal ileum is the most involved tract in Crohn's disease. The obstruction in this location is the most frequent complication. Acute or chronic presentations can occur. Surgery finds a role in the management of chronic strictures and in acute clinical presentations with complications not improving with conservative therapy.
  
  
  METHODS
  We investigate the outcome of patients with obstruction of the ileo-cecal bowel tract laparoscopically managed. It was analyzed the average operative time (OT), the conversion rate and the occurrence of re-operation due to surgical complications.
  
  
  RESULTS
  21 patients underwent an ileocecal resection for complicated Crohn's disease between January 2013 and December 2014. The admissions were performed in emergency in 42% of patients. The preintervention hospital stay was 5.8 (Sd 6.23). The mean operative time was 154 min (Sd 41). 28% of the procedures were converted to open surgery. The average hospital stay was 10 days (Sd 5) in uncomplicated patients. The morbidity rate was 28%. In 19% of cases a re-intervention was needed due to anastomotic leakage (3pts) and one hemoperitoneum for bleeding from the suture line.
  
  
  CONCLUSIONS
  Laparoscopy seems an affordable technique in the management of obstructive pattern of Crohn's disease. It should be the preferable approach in young patients that probably will be submitted to subsequent surgery for the same disease; in fact, the reduced adhesions formation provided by the less bowel manipulation make easy the subsequent access. Older patients had usually more post-operative morbidity and mortality mostly due to pre-existing conditions; if possible in these patients the treatment should be medical.
authors.forename: G
authors.initials: G
authors.lastname: Cocorullo
authors.forename: R
authors.initials: R
authors.lastname: Tutino
authors.forename: N
authors.initials: N
authors.lastname: Falco
authors.forename: G
authors.initials: G
authors.lastname: Salamone
authors.forename: T
authors.initials: T
authors.lastname: Fontana
authors.forename: L
authors.initials: L
authors.lastname: Licari
authors.forename: G
authors.initials: G
authors.lastname: Gulotta
mesh_terms: D000208:Acute Disease; D000328:Adult; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000209:etiology; D002908:Chronic Disease; D061887:Conversion to Open Surgery; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D007080:Ileocecal Valve / Q000601:surgery*; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome