The inflammatory process associated with Crohn's disease often makes d
issection difficult, even in ''open'' surgery. This study was undertak
en to determine if dissection and resection could be performed laparos
copically and whether it would benefit this group of patients. METHODS
: Between November 1992 and November 1994, laparoscopic-assisted intes
tinal resection was attempted in 18 patients with Crohn's disease and
was successfully completed in 14. One patient had ileal disease, requi
ring ileal resection with ileoileal anastomosis. The remainder had dis
ease requiring ileocolic resections. Muscle-splitting incisions averag
ing 5 cm in length were made to facilitate removal of specimens. RESUL
TS: Commencement of oral alimentation was possible at an average of 3-
6 (range, 1-7) days postoperatively Discharge occurred at an average o
f 6.6 (range, 4-9) postoperative days. In comparison, 14 patients oper
ated on by the authors for the same disease in the open manner during
the past six months stayed an average of 8.5 (range, 5-14) postoperati
ve days. Postoperative complications were minimal. CONCLUSIONS: On the
basis of this initial study, it appears that laparoscopic-assisted in
testinal resection can be readily performed in patients with Crohn's d
isease. In early experience, we have found that laparoscopic mobilizat
ion and resection may be difficult or impossible in patients with larg
e fixed masses, multiple complex fistulas, or recurrent Crohn's diseas
e. Extraction incisions are frequently so large in these patients that
they do not derive the same benefits from laparoscopic surgery that a
re enjoyed by patients without these findings. Most patients having la
paroscopic resections eat earlier, may require fewer narcotics, and ar
e able to be discharged from the hospital an average of two days earli
er than patients operated on in an open manner. In addition, it appear
s that laparoscopic-assisted intestinal resection results in a shorter
, easier convalescence and an earlier return to full activity.