LAPAROSCOPIC-ASSISTED INTESTINAL RESECTION FOR CROHNS-DISEASE - WHICHPATIENTS ARE GOOD CANDIDATES

This study was undertaken to determine preoperative criteria indicatin g which patients with Crohn's disease are most amenable to minimally i nvasive intestinal resection. Laparoscopic-assisted intestinal resecti on was attempted in 25 patients with Crohn's disease. Preoperative ass essment of all patients included physical examination and contrast rad iography. Laparoscopic intestinal resection was successfully completed in 19 patients. Four patients in whom both palpable mass and fistulou s disease were present required conversion to open surgery. One patien t found during surgery to have a fistula required conversion, as did o ne patient who had undergone previous ileocolic resection. In patients treated laparoscopically, oral alimentation discontinuation of parent eral narcotics, and hospital discharge were possible at an average of 3.4, 4.2, and 6.5 days postsurgery, respectively. Patients operated up on using open techniques stayed in the hospital an average of 8.5 days . Laparoscopic-assisted intestinal resection is beneficial to selected patients with Crohn's disease. The presence of both a fixed mass and fistula on preoperative evaluation is predictive of conversion to open laparotomy and should be considered a relative contraindication. Pati ents with either a fixed mass or a fistula alone are more amenable to laparoscopic-assisted intestinal resection, while patients with primar y uncomplicated Crohn's disease appear to be ideally suited to minimal ly invasive surgery.