PRELIMINARY EXPERIENCE WITH LAPAROSCOPIC INTESTINAL SURGERY FOR CROHNS-DISEASE

BACKGROUND: Laparoscopic techniques are being applied to the surgical management of various intestinal conditions, but few reports describe their use with Crohn's disease. PATIENTS AND METHODS: Over a 2-year pe riod, 31 selected patients with Crohn's disease underwent laparoscopic intestinal surgery: 18 women and 13 men, with a median age of 39 year s (range 22 to 79). Indications for operation included: primary termin al ileitis (13); recurrent ileitis (2); Crohn's colitis (3); rectovagi nal fistula (6); and severe perianal disease (7), Resections were lapa roscopically assisted with division of mesentery and anastomosis perfo rmed extracorporeally. Diversion procedures were performed using a two -cannula technique. RESULTS: Twenty-five of 31 procedures were complet ed laparoscopically: loop ileostomy or colostomy (12); ileocecectomy ( 10); segmental colon resection (2); and total abdominal colectomy with ileorectal anastomosis (1), Six cases were converted to conventional surgery secondary to extensive adhesions from prior surgery (2) or sev ere inflammation (4), No case was converted because of intraoperative complication. Median operative time for diversion procedures was 53 mi nutes (range 20 to 90) and for resections 195 minutes (range 90 to 380 ). Median blood loss was 100 mt (range 10 to 500), and there were no i ntraoperative complications. Only 1 postoperative complication occurre d: a myocardial infarction, Median times to passage of flatus and bowe l movement were both 3 days (range 1 to 6), Median time to discharge w as 6 days (2 to 21) for diversion patients, and 6 days (3 to 7) for re sected patients. CONCLUSIONS: Laparoscopic intestinal surgery, bath fo r resection and diversion, is feasible and safe for the management of selected patients with Crohn's disease, To determine if real advantage s exist for laparoscopy in the surgical treatment of Crohn's disease, further study is needed.