Laparoscopic-Assisted Versus Open Ileocolic Resection for Crohn's Disease: A Randomized Trial

Stefan Maartense, MD, PhD; Mich S. Dunker, MD, PhD; J Frederik M. Slors, MD, PhD; Miguel A. Cuesta, MD, PhD; Erik G. J. M. Pierik, MD, PhD; Dirk J. Gouma, MD, PhD; Daan W. Hommes, MD, PhD; Miriam A. Sprangers, MD, PhD; Willem A. Bemelman, MD, PhD

Disclosures

Annals of Surgery. 2006;243(2):143-149. 

In This Article

Abstract and Introduction

Abstract

Objective: The aim of the study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease in a randomized controlled trial.
Methods: Sixty patients were randomized for laparoscopic-assisted or open surgery. Primary outcome parameter was postoperative quality of life (QoL) during 3 months of follow-up, measured by SF-36 and GIQLI questionnaire. Secondary parameters were operating time, morbidity, hospital stay, postoperative morphine requirement, pain, and costs.
Results: Patient characteristics were not different. Conversion rate was 10% (n = 3). Median operating time was longer in laparoscopic compared with open surgery (115 versus 90 minutes; P < 0.003). Hospital stay was shorter in the laparoscopic group (5 versus 7 days; P = 0.008). The number of patients with postoperative morbidity within the first 30 days differed between the laparoscopic and open group (10% versus 33%; P = 0.028). There was no statistically significant difference in QoL between the groups during follow-up. Significant time effects were found on all scales of the SF-36 (P < 0.001) and the GIQLI score (P < 0.001). QoL declined in the first week, returned to baseline levels after 2 weeks, and was improved 4 weeks and 3 months after surgery. Median overall costs during the 3 months follow-up were significantly different: €6412 for laparoscopic and €8196 for open surgery (P = 0.042).
Conclusions: Although QoL measured by SF-36 and GIQLI questionnaires was not different for laparoscopic-assisted compared with the open ileocolic resection, morbidity, hospital stay, and costs were significantly lower.

Introduction

Ileocolic resection is the most frequent performed surgical procedure for the treatment of Crohn's disease, usually performed because of obstruction. Acceptable morbidity rates and improved quality of life (QoL) have been reported after surgery.[1,2,3]

Since the introduction of laparoscopic colectomy in 1991,[4] the experience in laparoscopic bowel surgery has increased gradually. Improved laparoscopic skills and introduction of new instruments have led to broad application of laparoscopy in benign and malignant diseases.[5,6,7] Recently, institutional and multicenter randomized trials have shown that laparoscopic surgery for colorectal cancer is safe and an acceptable alternative for open surgery.[8,9,10,11] Laparoscopic colorectal surgery for benign diseases has also met with great enthusiasm and widespread acceptance. Although a variety of laparoscopic intestinal surgical procedures have been done in different settings, many surgeons have been reluctant about its application in patients with inflammatory bowel disease. Induration of intestinal mesentery, active inflammation, fistula, immunodepression, and friable and dense adhesions can significantly complicate what is sometimes already technically challenging in open surgery. Only one randomized and a few comparative studies have been reported to compare laparoscopic-assisted ileocolic resection with the open procedure for Crohn's disease,[2,12,13,14,15,16] indicating the feasibility of the laparoscopic procedure in selected patients. The randomized trial by Milsom et al[13] also measured postoperative recovery in terms of recovery of pulmonary function. The question is whether this is a valid and clinically important endpoint in these usually young patients.

The aim of this study was to compare laparoscopic-assisted with open ileocolic resection for primary Crohn's disease in a randomized controlled trial with emphasis on feasibility and postoperative recovery measured by using validated QoL questionnaires.

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