[Laparoscopically assisted surgery for Crohn's disease]

Surgical treatment is often required by patients with Crohn's disease who have intestinal stricture or fistula. Minimally invasive laparoscopic surgery appears to be useful in such patients. Eight cases of intestinal stricture and/or fistula treated by laparoscopic surgery are reported.

In 1997, laparoscopic surgery was attempted and successfully completed in 18 patients Crohn's disease presenting with intestinal stricture and/or fistula, following strict nutritional therapy. Of the 8 patients with a fistula, one had an gastrocdic fistula, one had an ileovesical fistula, two had an colic fistula and three had ileoileal fistulas. Ileovesical, ileorectal and gastrocolic fistulas were divided with an intracorponeal automatic stapling device. Fourteen patients underwent ileocecal resection and four underwent ileal resection with laparoscopic assistance.

Postoperative pain was mild, oral intake was started an average of 1.4 days after operation. The patients were discharged an average of 8 days after operation. No complication was identified.

If Crohn's disease is treated adequately with conservative therapy, laparoscopic surgery is relatively easy, even when there are adhesions and fistulas. Since the incision is extremely small with this method, postoperative adhesions are minimized. This procedure has the advantage of allowing repeated laparoscopic surgery with minimal morbidity. Minimal invasiveness and rapid return to normal activity may make laproscopic surgery the treatment of choice for patients with Crohn's disease who require surgical treatment.