クローン病に対する標準化された5段階3トロカール腹腔鏡下回盲部切除術：三次IBDセンターにおける5年間の実体験

Surgical management of Crohn's disease remains challenging because of disease complexity and substantial variability in operative techniques across centres. Despite the widespread adoption of minimally invasive surgery, laparoscopic ileocolic resection is still characterized by limited technical standardization and heterogeneous perioperative outcomes. Unlike oncological colorectal surgery, inflammatory bowel disease surgery lacks widely accepted, reproducible technical frameworks.

To describe a standardized five-step, three-trocar laparoscopic ileocolic resection for Crohn's disease, aimed at improving reproducibility, safety, and operative efficiency in both elective and emergency settings.

This technical note details a structured laparoscopic approach based on: (1) systematic intraoperative bowel assessment, (2) a bottom-up medial-to-lateral dissection, (3) mandatory identification of retroperitoneal structures, (4) selective mesenteric division using a 'clip-and-go' technique with preservation of the main ileocolic vessels and (5) a standardized intracorporeal isoperistaltic side-to-side anastomosis. The technique is illustrated by a dedicated surgical video, including complex inflammatory scenarios such as thickened mesentery and abscess formation. A consecutive cohort of patients undergoing laparoscopic ileocolic resection for Crohn's disease between 2020 and 2025 at a tertiary IBD referral centre was retrospectively analysed.

A total of 110 patients were included. No conversions to open surgery occurred. The mean operative time for isolated ileocolic resection was 116 minutes. The anastomotic dehiscence rate was 2.7%, supporting the feasibility and safety of the standardized laparoscopic workflow in real-life Crohn's disease surgery.

The proposed five-step, three-trocar laparoscopic ileocolic resection represents a reproducible and safe technical framework for Crohn's disease surgery. This standardized approach may reduce intraoperative variability, facilitate surgical training, and contribute to more consistent perioperative outcomes in inflammatory bowel disease.