Laparoscopy in Crohn's Disease

 

 Buy Article Permissions and Reprints

ABSTRACT

Crohn's disease represents a challenging operative dilemma. The nature of the disease increases the technical complexity of operations, their morbidity, and the likelihood of multiple operations. In this setting, the advantages of laparoscopic surgery, including shorter hospital stays, less adhesion formation, fewer wound complications, and faster recovery of bowel function, are particularly beneficial to the patient. Patients with Crohn's disease requiring operations in the elective and semi-elective setting can all be approached initially laparoscopically. The surgeon's skill set should include extensive experience in advanced laparoscopic bowel surgery as well as open management of Crohn's disease and its complications. Strict adherence to the basic tenet of bowel preservation is imperative. The operations most commonly performed for Crohn's disease include diagnostic laparoscopy, stricturoplasty, small bowel resection, ileocolic resection, colectomy, repair of fistulae, and gastrojejunostomy for bypass of gastric or duodenal disease. Postoperative management includes resumption of steroids, typically without the need for “stress-dosing,” bowel rest for a short period, and pain control, which is also less than that experienced with a laparotomy.

REFERENCES

• 1 Wu J S, Birnbaum E H, Kodner I J, Fry R D, Read T E, Fleshman J W. Laparoscopic-assisted ileocolic resections in patients with Crohn's disease: are abscesses, phlegmons, or recurrent disease contraindications?.  Surgery. 1997;  122 682-688
  CrossrefPubMedGoogle Scholar
• 2 Bemelman W A, Slors J F, Dunker M S et al.. Laparoscopic-assisted vs. open ileocolic resection for Crohn's disease: a comparative study.  Surg Endosc. 2000;  14 721-725
  CrossrefPubMedGoogle Scholar
• 3 Kishi D, Nezu R, Ito T et al.. Laparoscopic-assisted surgery for Crohn's disease: reduced surgical stress following ileocolectomy.  Surg Today. 2000;  30 219-222
  CrossrefPubMedGoogle Scholar
• 4 Milsom J W, Hammerhofer K A, Bohm B, Marcello P, Elson P, Fazio V W. Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn's disease.  Dis Colon Rectum. 2001;  44 1-8
  CrossrefPubMedGoogle Scholar
• 5 Benoist S, Panis Y, Beaufour A, Bouhnik Y, Matuchansky C, Valleur P. Laparoscopic ileocecal resection in Crohn's disease: a case-matched comparison with open resection.  Surg Endosc. 2003;  17 814-818
  CrossrefPubMedGoogle Scholar
• 6 Duepree H J, Senagore A J, Delaney C P, Brady K M, Fazio V W. Advantages of laparoscopic resection for ileocecal Crohn's disease.  Dis Colon Rectum. 2002;  45 605-610
  CrossrefPubMedGoogle Scholar
• 7 Bergamaschi R, Pessaux P, Arnaud J P. Comparison of conventional and laparoscopic ileocolic resection for Crohn's disease.  Dis Colon Rectum. 2003;  46 1129-1133
  CrossrefPubMedGoogle Scholar
• 8 Hasegawa H, Watanabe M, Nishibori H, Okabayashi K, Hibi T, Kitajima M. Laparoscopic surgery for recurrent Crohn's disease.  Br J Surg. 2003;  90 970-973
  CrossrefPubMedGoogle Scholar
• 9 Shore G, Gonzalez Q H, Bondora A, Vickers S M. Laparoscopic vs. conventional ileocolectomy for primary Crohn disease.  Arch Surg. 2003;  138 76-79
  PubMedGoogle Scholar
• 10 Young-Fadok T M, Hall-Long K, McConnell E J, Gomez R G, Cabanela R L. Advantages of laparoscopic resection for ileocolic Crohn's disease. Improved outcomes and reduced costs.  Surg Endosc. 2001;  15 450-454
  CrossrefPubMedGoogle Scholar

SUGGESTED READINGS

• 11 Canin-Endres J, Salky B, Gattorno F, Edye M. Laparoscopic assisted intestinal resection in 88 patients with Crohn's disease.  Surg Endosc. 1999;  13 595-599
  CrossrefPubMedGoogle Scholar
• 12 Casillas S, Delaney C P. Laparoscopic surgery for inflammatory bowel disease.  Dig Surg. 2005;  22 135-142
  PubMedGoogle Scholar
• 13 Hanauer S B, Sandborn W. Mangement of Crohn's disease in adults.  Am J Gastroenterol. 2001;  96(3) 635-643
  CrossrefPubMedGoogle Scholar
• 14 Noel J K, Fahrbach K, Estok R et al.. Minimally invasive colorectal resection outcomes: short-term comparison with open procedures.  J Am Coll Surg. 2007;  204(2) 291-307
  CrossrefPubMedGoogle Scholar
• 15 Reissman P, Salky B A, Edye M, Wexner S D. Laparoscopic surgery in Crohn's disease indications and results.  Surg Endosc. 1996;  10(12) 1201-1204
  CrossrefPubMedGoogle Scholar
• 16 Schwandner O, Schiedeck T, Bruch H P. The role of conversion in laparoscopic colorectal surgery. Do predictive factors exist?.  Surg Endosc. 1999;  13 151-156
  CrossrefPubMedGoogle Scholar

Barry A SalkyM.D. 

Division of Laparoscopic Surgery, Mount Sinai School of Medicine

5 E. 98th St., Box 1259, New York, NY 10029

Email: barry.salky@mountsinai.org