Laparoscopy in Crohn Disease: Learning Curve and Current Practice

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Surgery

Background:

• Laparoscopic surgery for Crohn disease (CD) is increasingly utilized.
• However, CD laparoscopy is associated with significant rates of conversion to open laparotomy.

Purpose of the Study:

• To identify preoperative characteristics that predict the need for conversion from laparoscopy to laparotomy in CD patients.
• To aid in selecting the optimal surgical approach (laparoscopy vs. laparotomy) for Crohn disease.

Main Methods:

• Retrospective analysis of 458 abdominal surgeries for CD performed between 2004 and 2016.
• Comparison of outcomes between patients undergoing laparoscopy, laparotomy, and those converted from laparoscopy to laparotomy.

Main Results:

• Of 427 patients, 301 (66%) underwent laparoscopy and 157 (34%) underwent laparotomy.
• Conversion to laparotomy occurred in 21.6% of laparoscopic cases, often within 15 minutes.
• Predictive factors for conversion included recurrent disease, dense adhesions, pelvic sepsis, large inflammatory mass, and thickened mesentery.

Conclusions:

• Despite advancements, a substantial proportion of CD laparoscopy cases require conversion.
• Preoperative identification of factors like adhesions, sepsis, and disease extent can guide the choice between laparoscopy and laparotomy.
• Considering an open approach preoperatively or early conversion decisions are vital for patient management in complex CD cases.