Minimally invasive surgery for ileo-colic Crohn's disease

OBJECTIVE: Patients requiring surgery for Crohn's disease are likely to undergo further surgery due to recurrent disease. A prospective study of laparoscopic-assisted surgery for ileo-colic Crohn's disease is reported. METHOD: Forty-one patients (26 female; median age 35 years) with ileo-colic Crohn's disease, without evidence of either fistula or abscess formation underwent laparoscopic-assisted surgery. All had medical therapy, including steroids, but had failed to respond or relapsed. Sixteen patients (39%) had previous surgery for Crohn's disease and 26 (63.4%) had previous abdominal surgery. Laparoscopic procedures (n=42) included ileocaecal/ileocolic resection (n=39), small bowel resection (n=1) and strictureplasty (n=2). RESULTS: The median operating time was 90 min (range 60-180). There were 6 conversions (14.6%). Of the 35 patients whose operation was completed laparoscopically, the median postoperative stay was 5 days (3-9) and the median time to full activity was 20 days (7-49). No major complications or death were recorded. The median follow up (34 out of 35) after surgery is 15.3 months (1-55). Twenty-four patients remain symptom free and 4 have minimal symptoms with no clinical or radiological evidence of recurrence of Crohn's disease. Six have however, developed recurrence requiring medical (n=5) and surgical (n=1) treatment. CONCLUSION: Laparoscopic-assisted surgery for Crohn's disease is feasible. It has the advantage of minimizing hospital stay and promoting early recovery in a group of patients who are likely to have further surgery due to the nature of the disease.