LAPAROSCOPIC SURGERY FOR INFLAMMATORY BOWEL-DISEASE

In the setting of inflammatory bowel disease (IBD), laparoscopic appro aches have been avoided because of the often fragile intestinal tissue , thickened mesentery, malnutrition, immunosuppression, and the presen ce of dense adhesions. In this article, we report 10 successfully mana ged laparoscopic cases in IBD patients (five with ulcerative colitis, five with Crohn's Disease). Patients with ulcerative colitis underwent total abdominal colectomies, mucosal proctectomies, J-pouch construct ion, and diverting ileostomies. Procedures in patients with Crohn's di sease included ileocecectomy (3), sigmoid colectomy with takedown of a transverse colonic fistula (1), and stricturoplasty (1). One of the 1 0 cases was converted to an open technique for technical reasons. Six of the 10 patients were on high dose corticosteroids for disease contr ol. Hospital stay ranged from 6-13 days, with a median of 7 days. The morbidity rate was 20 per cent, and included one case of mild postoper ative pancreatitis in a Crohn's disease patient and one delayed peri-i leostomy fistula in an ulcerative colitis patient. There was no mortal ity. Based on these results, we conclude that laparoscopic intestinal surgery is both feasible and safe in selected patients with inflammato ry bowel disease. Use of laparoscopic techniques in these patients may reduce hospital stay, lessen adhesion formation, and improve cosmetic results in this generally young group of patients.