Laparoscopic assisted surgery for Crohn's disease an initial experience and results

The inflammatory process associated with Crohn's disease often makes dissection difficult, even in open surgery. The aim of this study was to assess the technical feasibility, safety and indication of laparoscopic assisted procedures performed in patients with Crohn's disease. Records of patients undergoing surgical operation for Crohn's disease from 1993 to 1998 at our hospital were reviewed. Intestinal resection was performed laparoscopically in 24 patients (LAP) and by open technique in 23 patients(OPEN). No significant differences existed as to age, gender, body-mass-index and previous surgery. In the laparoscopic group, seven operations (CON) were converted to open laparotomy (29%) because of large inflammatory mass and/or fistula. The mean intraoperative blood loss was significantly higher in CON- and OPEN-groups than in LAP-group (P < 0.01). Major complications occurred only in one patient who underwent laparoscopic assisted high anterior resection. Patients who underwent laparoscopic operation tolerated p.o. liquids sooner than patients who underwent open surgery (median: 2 vs. 5 day, P < 0.05). Compared with the CON- and OPEN-groups, patients in LAP-group had lower analgesic requirements (median: 3 vs. 6 and 5 day, P < 0.01). The median postoperative length of stay was significantly shorter in LAP-group than in OPEN-group (median: 11 vs. 14 day, P < 0.05). Our study showed that LAP is technically feasible for Crohn's disease. The preoperative correct diagnosis and selection of indications are very important, because the laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complex fistulas, or recurrent Crohn's disease.