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Laparoscopic surgery for complex Crohn's disease: perioperative and long-term results from a propensity matched
Tara M Connelly1, Cillian Clancy1, Leonardo C Duraes1
1Digestive Disease and Surgery Institute, Dept. of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Ave./A 30, Cleveland, OH, 44195, USA.
Insights
Laparoscopic surgery for complicated Crohn's disease (CD) offers shorter operative times and hospital stays compared to open surgery. Matched patient data show equivalent long-term outcomes, with fewer cases of postoperative sepsis in the laparoscopic group.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Laparoscopic surgery for complicated Crohn's disease (CD) presents technical challenges.
- Previous studies often compare heterogeneous patient groups, limiting direct comparisons between laparoscopic and open approaches.
- Propensity score matching allows for a more robust comparison of perioperative and long-term outcomes.
Purpose of the Study:
- To compare perioperative and long-term outcomes of matched patients undergoing laparoscopic versus open colonic and ileocolonic resection for complicated Crohn's disease.
- To evaluate operative time, blood loss, complications, subsequent surgeries, hernia repair, and stoma reversal rates.
Main Methods:
- A 1:1 propensity score matching was performed on laparoscopic and open Crohn's disease patient cohorts.
- Matching criteria included age, BMI, sex, indication, ASA grade, prior abdominal surgery, and postoperative medication use.
- Perioperative outcomes (operative time, blood loss, complications) and long-term outcomes (subsequent surgery, hernia repair, stoma reversal) were analyzed.
Main Results:
- Matched analysis of 386 patients (193 open/193 lap) with a mean follow-up of 9.8 years.
- Laparoscopic surgery was associated with significantly shorter length of stay (LOS) and operative time.
- No significant differences were observed in mortality, reoperation, or symptomatic hernia rates between the groups. Laparoscopic patients had lower rates of postoperative sepsis.
Conclusions:
- In complicated Crohn's disease, laparoscopic surgery in matched cohorts leads to reduced operative times and LOS.
- Outcomes regarding mortality, reoperation, and symptomatic hernia rates are comparable between laparoscopic and open surgery.
- Laparoscopic approaches are associated with a reduced likelihood of postoperative sepsis.
Purpose:
Laparoscopic surgery for complicated Crohn's (CD) is often technically challenging. Previous studies are limited by the comparison of heterogeneous cohorts of patients undergoing laparoscopic vs open surgery. We aimed to compare perioperative and long-term outcomes of matched patients undergoing laparoscopic and open colonic and ileocolonic resection. Primary outcomes were operative time, blood loss, and complications. Long-term outcomes were subsequent intraabdominal CD surgery, incisional hernia repair, and stoma reversal rates.
Methods:
Laparoscopic and open CD patients were 1:1 propensity score matched on age, body mass index, sex, indication, ASA grade, prior abdominal surgery, and postoperative Crohn's medication use based on the laparoscopic approach.
Results:
A total of 906 patients underwent surgery for complex CD. After propensity matching, 386 were analyzed (193 open/193 lap, 51.3% male, mean age 33.9 + / - 12.6). Mean follow-up was 9.8 (range 7.9-12.1) years. Length of stay [(LOS) 6 (4, 8) vs 8 (5, 11) days, p < 0.001] and operative time [154 (110, 216) vs 176 (126, 239) min, p = 0.03] were shorter in the laparoscopic group. There was no difference in other complications or mortality. After adjusting for postoperative medications, no association was found between operative approach and subsequent intra-abdominal operation or incisional hernia repair. Laparoscopic patients were less likely to have postoperative sepsis [OR 0.40 (0.18, 0.91), p = 0.03].
Conclusion:
In the setting of complicated Crohn's, in matched cohorts, laparoscopic surgery is associated with reduced operative times and LOS. Mortality, reoperation, and symptomatic hernia rates were equivalent to open surgery. Patients undergoing laparoscopic surgery are less likely to experience postoperative sepsis.
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