Faculty Collaboration Database

Preliminary experience with laparoscopic intestinal surgery for Crohn's disease. Am J Surg 1996 Jan;171(1):52-5; discussion 55-6

Date

01/01/1996

Pubmed ID

8554151

DOI

10.1016/S0002-9610(99)80073-7

Scopus ID

2-s2.0-0030032213 (requires institutional sign-in at Scopus site)   125 Citations

Abstract

BACKGROUND: Laparoscopic techniques are being applied to the surgical management of various intestinal conditions, but few reports describe their use with Crohn's disease.

PATIENTS AND METHODS: Over a 2-year period, 31 selected patients with Crohn's disease underwent laparoscopic intestinal surgery: 18 women and 13 men, with a median age of 39 years (range 22 to 79). Indications for operation included: primary terminal ileitis (13); recurrent ileitis (2); Crohn's colitis (3); rectovaginal fistula (6); and severe perianal disease (7). Resections were laparoscopically assisted with division of mesentery and anastomosis performed extracorporeally. Diversion procedures were performed using a two-cannula technique.

RESULTS: Twenty-five of 31 procedures were completed laparoscopically: loop ileostomy or colostomy (12); ileocecectomy (10); segmental colon resection (2); and total abdominal colectomy with ileorectal anastomosis (1). Six cases were converted to conventional surgery secondary to extensive adhesions from prior surgery (2) or severe inflammation (4). No case was converted because of intraoperative complication. Median operative time for diversion procedures was 53 minutes (range 20 to 90) and for resections 195 minutes (range 90 to 380). Median blood loss was 100 mL (range 10 to 500), and there were no intraoperative complications. Only 1 postoperative complication occurred: a myocardial infarction. Median times to passage of flatus and bowel movement were both 3 days (range 1 to 6). Median time to discharge was 6 days (2 to 21) for diversion patients, and 6 days (3 to 7) for resected patients.

CONCLUSIONS: Laparoscopic intestinal surgery, both for resection and diversion, is feasible and safe for the management of selected patients with Crohn's disease. To determine if real advantages exist for laparoscopy in the surgical treatment of Crohn's disease, further study is needed.

Author List

Ludwig KA, Milsom JW, Church JM, Fazio VW

Author

Kirk A. Ludwig MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Anus Diseases
Blood Loss, Surgical
Colectomy
Colitis
Colostomy
Crohn Disease
Female
Humans
Ileitis
Ileostomy
Intraoperative Complications
Laparoscopy
Male
Middle Aged
Myocardial Infarction
Postoperative Complications
Rectovaginal Fistula
Time Factors