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Laparoscopic approach for inflammatory bowel disease is a real alternative to open surgery: an experience with 574
Léon Maggiori1, Antoine Khayat, Xavier Treton
1*Department of Colorectal Surgery, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France †Department of Gastroenterology, IBD, and Nutritive Support, Beaujon Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Clichy, France; and ‡Department of Clinical Research, Lariboisière Hospital, Assistance publique-Hôpitaux de Paris, Université Paris VII, Paris, France.
Objective:
This study aimed to report a 14-year experience of laparoscopic approach for inflammatory bowel disease (IBD), including complicated and recurrent cases.
Background:
Feasibility of laparoscopic approach for IBD surgical management has been questioned.
Methods:
From 1998 to 2012, all patients undergoing colorectal resection for IBD were prospectively enrolled. Adjusted risks of conversion and severe postoperative morbidity after laparoscopic resection were computed, according to a multivariate regression logistic model.
Results:
A total of 790 consecutive resections for IBD were performed on 633 patients. Laparoscopic approach was performed in 574 (73%) procedures, including 286 ileocecal resections (48%), 118 subtotal colectomies (19%), 134 ileal pouch-anal anastomoses (21%), 23 segmental colectomies (8%), and 18 abdominoperineal resections (4%). A total of 145 (25%) complex laparoscopic procedures were performed, considered as such because of iterative surgery for IBD recurrence (n = 66, 12%) or because of intra-abdominal-abscess or fistula (n = 93, 16%). Conversion to laparotomy occurred in 67 procedures (12%). Postoperative death occurred in 1 patient (0.2%). Severe postoperative morbidity occurred in 66 laparoscopic procedures (13%). Splitting the study in 5 time periods, the rate of laparoscopic procedures significantly increased from 42% in period 1 to 80% in period 5 (P < 0.001). With time, the rate of complex procedures performed laparoscopically significantly increased (P = 0.023), whereas both mean adjusted risks of conversion and severe postoperative morbidity significantly decreased (P < 0.001).
Conclusions:
Laparoscopic approach is a safe and effective alternative to open surgery for IBD management. With growing experience, the rate of laparoscopic complex procedures increased, whereas adjusted risks of conversion and severe postoperative morbidity significantly decreased.
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