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Comparison of laparoscopically assisted and conventional ileocolic resection for Crohn's disease
O Alabaz1, A J Iroatulam, A Nessim
1Department of Colorectal Surgery, Cleveland Clinic Florida, Fort Lauderdale 33309, USA.
Objective:
To compare safety, outcome, and feasibility of laparoscopic assisted and conventional laparotomy for ileocolic resection in Crohn's disease.
Design:
Retrospective study.
Setting:
Private clinic, USA.
Subjects:
74 patients who had ileocolic resection and anastomosis for Crohn's disease between August 1991 and July 1996, 48 through conventional laparotomy and 26 in whom it was laparoscopically assisted.
Main Outcome Measures:
Age, operating time, duration of hospital stay, early and late morbidity, and patients' subjective assessment.
Results:
The mean age was 42 (+/- 17) in the conventional group and 40 (+/- 15) in the laparoscopically assisted group. The mean operating time was significantly shorter in the conventional group, 90.5 +/- 3.7 minutes, compared with 150 +/- 1.2 minutes in the laparoscopic-assisted group (p < 0.0001), but they stayed in hospital significantly longer, 9.6 +/- 0.6 days in the conventional group, compared with 7 +/- 0.8 days in the laparoscopic-assisted group (p < 0.0001). There were no differences between the groups in the incidence of early complications or the cost of admission, but at a mean follow up of 30 months (range 2-59) significantly more patients in the conventional group had developed symptomatic bowel obstruction (15/48 compared with 2/26, p = 0.02). 31 patients in the conventional group (65%) and 16 in the laparoscopically assisted group (62%) returned their subjective assessments. There were no differences between the groups in the number with changed bowel habits, use of drugs for bowel movement, or restricted diet, but patients in the laparoscopically assisted group returned to work more quickly (3.7 +/- 1.2 weeks) compared with 8.2 +/- 1.1 weeks in the conventional group, had better cosmetic results (14/16 compared with 13/31, p = 0.004), and were more likely to have improved social and sexual lives (8/16 compared with 5/31, p = 0.02).
Conclusion:
Laparoscopically assisted ileocolic resection for Crohn' s disease is safe and has less morbidity than conventional laparotomy.