Laparoscopy Best for Ileocolectomy in Crohn's Disease

Laurie Barclay, MD

January 27, 2003

Jan. 27, 2003 — Laparoscopy should be the first choice for patients with Crohn's disease in need of ileocolectomy, according to the results of a retrospective, nonrandomized analysis reported in the January issue of the Archives of Surgery.

"When performed by surgeons with adequate experience, laparoscopic surgery seems to demonstrate advantages over conventional operations," write Gregg Shore, MD, and colleagues from the University of Alabama at Birmingham. "We believe at this time that laparoscopic ileocolectomy should be considered the first-line surgical option for most primary resections for Crohn disease localized to the ileocolic region."

From July 1, 1996, to June 30, 2001, a total of 40 patients with Crohn's disease were enrolled in the study; 20 patients underwent laparoscopic ileocolectomy and 20 underwent conventional ileocolectomy. In the laparoscopic group, mean age was 34.7 years (range, 20 - 68 years) and male-female ratio was 1:2. In the conventional group, mean age was 40.0 years (range, 18 - 75 years), and male-female ratio was 1:1. Mean follow-up was 17.2 months in the laparoscopic group (range, 2.3 - 59.9 months) and 18.7 months in the conventional group (range, 1.0 - 37.5 months).

There were no perioperative deaths in either group, and operating time was not significantly different between groups. Outcome was better in the laparoscopic group than in the conventional group in terms of morbidity (0% vs. 5%), blood loss (77.2 mL; range, 25 - 350 mL vs. 265.5 mL; range, 100 - 400 mL; P < .001); incision length (5.5 cm; range, 3 - 12 cm vs. 13.5 cm; range, 8 - 18 cm; P < .001), return of bowel function (1.70 vs. 2.63 days; P < .001), and resumption of a regular diet (1.35 vs. 2.73 days; P < .001).

Mean length of stay was significantly shorter in the laparoscopic group (4.25 vs. 8.25 days; P < .001) and hospital charges were lower ($9,614 vs. $17,079; P<.05).

"Laparoscopic-assisted ileocolectomy for primary Crohn disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn disease should be considered as the preferred operative approach for primary resections," the authors write. "The total hospital charges were significantly less in favor of the laparoscopic group, despite the longer operative time and increased cost of surgical equipment, and can no longer be an argument for those who oppose a laparoscopic approach in this patient population."

Arch Surg. 2003;138:76-79

Reviewed by Gary D. Vogin, MD

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