LAPAROSCOPIC SURGERY IN CROHNS-DISEASE - INDICATIONS AND RESULTS

Background: An effort was made to assess the feasibility, safety, and outcome of laparoscopic procedures performed in patients with Crohn's disease. Methods: A prospectively maintained laparoscopic database was analyzed regarding operation time, intra- and postoperative complicat ions, conversion to laparotomy, and length of hospitalization. Fifty-o ne patients (23 males and 28 females) with a mean age of 36 (20-79) ye ars underwent a laparoscopic or laparoscopic-assisted procedure for Cr ohn's disease. The indications included terminal ileitis in 31 patient s, colitis in 11, perianal disease in four, duodenal Crohn's disease i n three, and rectovaginal and rectourethral fistula in one patient eac h. Thirty-two patients underwent an ileocolic resection; total abdomin al colectomy with ileorectal anastomosis was performed in six patients with end ileostomy in one, take down of end ileostomy and ileorectal anastomosis in three, duodenal bypass gastrojejunostomy in three, and loop ileostomy in six patients. Results: The mean operating time was 2 .4 (0.6-4.5) h and the mean length of hospital stay was 5.1 (3-18) day s. Eight complications were noted in seven patients (14%), which inclu ded enterotomy in two patients, bleeding in two, stoma obstruction in two, pelvic sepsis in one, and efferent limb obstruction in one. The p rocedure was converted to laparotomy in seven patients (14%) due to a large inflammatory mass in five and to bleeding in two patients; there was no mortality. Conclusion: Laparoscopic surgery is a feasible, ver satile, and safe modality in the surgical management of Crohn's diseas e. Despite the often-malnourished state of these steroid-dependent pat ients with intraabdominal inflammatory conditions, morbidity, procedur al length, and length-of-hospitalization data are all similar to resul ts previously reported for less-challenging laparoscopic colorectal pr ocedures.