Laparoscopic Approach for Inflammatory Bowel Disease Is a Real Alternative to Open Surgery

An Experience With 574 Consecutive Patients

Léon Maggiori, MD; Antoine Khayat, MD; Xavier Treton, MD, PhD; Yoram Bouhnik, MD, PhD; Eric Vicaut, MD, PhD; Yves Panis, MD, PhD

Disclosures

Annals of Surgery. 2014;260(2):305-310. 

In This Article

Patients and Methods

From June 1998 to July 2012, all patients who underwent an intestinal resection for IBD were enrolled in this prospective study. Data were entered in our prospectively maintained, local ethics committee–approved, IBD database. Data collection included patient charts (age, sex, surgical history, body mass index, etc), disease characteristics (diagnosis, number of previous IBD acute episodes, use of medical treatment before surgery, etc), details on surgical procedure (procedure performed, type of anastomosis, use of a temporary stoma, etc), conversion into laparotomy (defined as an unplanned abdominal incision of ≥5 cm), length of hospital stay, and postoperative morbidity (defined according to the Clavien-Dindo classification[25]). In this study, complex procedures were defined as a colorectal resection with an operative finding of an intra-abdominal abscess, an enteroenteric fistula, an enterovesical fistula, an enterorectocolic fistula, an enterocutaneous fistula, and/or a redoresection for recurrent disease at a previously performed anastomosis.

Preoperative workout, surgical technique, and postoperative management were standardized and have been detailed in previous publications.[22,23,26–28]

This study was performed according to an observational cohort design, comparing 5 periods defined as follows: procedures performed from 1998 to 2001 (period 1), 2002 to 2004 (period 2), 2005 to 2007 (period 3), 2008 to 2010 (period 4), and 2011 to 2012 (period 5). No patient was excluded from the analysis.

Descriptive analyses are presented as mean ± standard deviation (ranges) for quantitative data and as number of cases (percentage of cases) for categorical variables. Comparisons were realized using Student t, Mann-Whitney U, or Kruskal-Wallis H tests for quantitative data (depending on their distribution and number of tested groups) and Pearson [chi]2 or Fisher exact tests for categorical variables. Adjusted risks of conversion and severe postoperative morbidity after laparoscopic resection were computed individually according to a multivariate regression logistic model, which included all variables with a P value of less than 0.2 in univariate analysis. Those variables included sex, diagnosis, type of procedure, preoperative steroids therapy, preoperative immunosuppressive therapy, complex procedure, preoperative denutrition, and American Society of Anesthesiologists (ASA) score. Area under the curve of the logistic regression model was 0.757 regarding risk of conversion and 0.768 regarding risk of severe morbidity. All tests were 2-sided, with a level of significance set at P value of less than 0.05. All analyses were performed using the Statistical Package for the Social Sciences (SPSS) software (SPSS Inc., version 17.0, Chicago, IL).

This study was conducted according to the ethical standards of the Committee on Human Experimentation of our institution and reported according to the Strengthening the Reporting of Observational Studies in Epidemiology guidelines.[29]

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