LAPAROSCOPIC-ASSISTED INTESTINAL RESECTION FOR CROHNS-DISEASE

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.