Laparoscopic approach in patients with recurrent Crohn's disease

The purpose of this study is to review our experience with laparoscopic management of Crohn's disease including patients with prior Crohn's-related abdominal surgery. All cases of Crohn's patients who underwent laparoscopic attempt for management of disease from April 2005 to October 2010 (n = 130) at a single institution were retrospectively reviewed. Evaluated datapoints include: prior abdominal surgery for Crohn's disease, operative time, rate of conversion, and complication rate. Of the 130 patients, 82 (63.1%) patients had no prior abdominal surgery and 48 (36.9%) patients had previous bowel surgery with mean age of 35.3 (3.5-79) and 41.3 (15-66) years, respectively. Operative time with no prior surgery was 106 (23-245) minutes, and with prior surgery was 100 (26-229) minutes. Estimated blood loss with no prior surgery was 116 (5-800) mL, and with prior surgery was 123 (5-800) mL. Conversion from laparoscopic to open surgery in those with no prior surgery was 17.1 per cent and in those with prior surgery, 20.8 per cent (P = 0.64). Postoperative complications were found in 13 patients (15.9%) without prior abdominal surgery and 13 patients (27.1%) with prior surgery (P = 0.17). The most common postoperative complication in both groups was infection/abscess (8.5%). The laparoscopic management of recurrent Crohn's disease is a safe and technically feasible option, even in those patients with prior history of Crohn's-related abdominal surgery, with a low complication rate and low conversion rate. The utility of the laparoscopic approach in Crohn's patients faced with repeat abdominal procedures may be beneficial in the long-term and should be considered as a method to limit morbidity.