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Laparoscopic-assisted intestinal resection for Crohn's disease
J J Bauer1, M T Harris, N M Grumbach
1Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Purpose:
The inflammatory process associated with Crohn's disease often makes dissection difficult, even in "open" surgery. This study was undertaken to determine if dissection and resection could be performed laparoscopically and whether it would benefit this group of patients.
Methods:
Between November 1992 and November 1994, laparoscopic-assisted intestinal resection was attempted in 18 patients with Crohn's disease and was successfully completed in 14. One patient had ileal disease, requiring ileal resection with ileoileal anastomosis. The remainder had disease requiring ileocolic resections. Muscle-splitting incisions averaging 5 cm in length were made to facilitate removal of specimens.
Results:
Commencement of oral alimentation was possible at an average of 3.6 (range, 1-7) days postoperatively. Discharge occurred at an average of 6.6 (range, 4-9) postoperative days. In comparison, 14 patients operated on by the authors for the same disease in the open manner during the past six months stayed an average of 8.5 (range, 5-14) postoperative days. Postoperative complications were minimal.
Conclusions:
On the basis of this initial study, it appears that laparoscopic-assisted intestinal resection can be readily performed in patients with Crohn's disease. In our early experience, we have found that laparoscopic mobilization and resection may be difficult or impossible in patients with large fixed masses, multiple complex fistulas, or recurrent Crohn's disease. Extraction incisions are frequently so large in these patients that they do not derive the same benefits from laparoscopic surgery that are enjoyed by patients without these findings. Most patients having laparoscopic resections eat earlier, may require fewer narcotics, and are able to be discharged from the hospital an average of two days earlier than patients operated on in an open manner. In addition, it appears that laparoscopic-assisted intestinal resection results in a shorter, easier convalescence and an earlier return to full activity.