Laparoscopy for inflammatory bowel disease: pushing the envelope

Despite the slower learning curve of laparoscopic colectomy and the lack of prospective randomized trials, laparoscopic procedures have repeatedly demonstrated a shortened length of stay, reduction in postoperative ileus, and earlier resumption of diet. However, laparoscopy in inflammatory bowel disease has unique challenges that must be overcome. For the patient with uncomplicated terminal ileal Crohn's disease, there are definite reproducible advantages to a minimally invasive approach. As surgeons gain experience, more complex cases may be attempted laparoscopically with a low threshold to alternate the approach if difficulties are encountered. We will continue to "push the envelope" in patients with complex Crohn's disease to allow more to be done in complex cases. For the patient with Crohn's colitis and ulcerative colitis, the role of a minimally invasive approach is less well defined. In experienced hands, a laparoscopic total colectomy can be performed safely and offers the patient all the advantages seen with laparoscopic segmental resection. Outcomes are likely to improve with better training, techniques, and equipment. As the field of minimally invasive surgery continues to expand, what is being "pushed" today will be routine in the future.