Laparoscopic-assisted bowel resections in inflammatory bowel disease: state of the art

The objectives of this paper are to review the rational, the present result s and future of laparoscopic-assisted bowel surgery in patients with inflam matory bowel disease (IBD). Only a few centres in the world report on laparoscopic bowel resection in I BD that include stoma surgery, ileocolic resection, left, right and (sub)to tal colectomy for Crohn's disease, and subtotal or restorative total procto colectomy (ileal pouch anal procedures). The combined series report conversion rates between 2.5% and 22.2%. Ileocol ic resection, stoma creation, stricturoplasty and segmental small bowel res ection are associated with an acceptable length of surgery, but laparoscopi c(-assisted) total colectomy or restorative proctocolectomy still demand up to 4-6 hours of operative time. The few randomised studies addressing lapa roscopic-assisted (segmental) bowel surgery versus conventional surgery dem onstrated significantly less pain, a quicker return to self-care and a shor ter hospital stay. The results of the series reporting on laparoscopic-assi sted (ileo)colectomy in IBD are similar to those from these randomised stud ies. Laparoscopic-assisted subtotal colectomy and restorative proctocolecto my have no benefit compared with conventional surgery other than superior c osmesis. Morbidity of laparoscopic (ileo)colectomy in IBD is low, that of l aparoscopic-assisted subtotal colectomy and restorative proctocolectomy rem ains to be seen. The various laparoscopic bowel resections done in IBD are all feasible. The first series describing laparoscopic surgery for IBD indicate that laparos copic-assisted segmental (ileo)colectomy is safe and is the preferred appro ach provided it is done in a centre specialised in the treatment of IBD and by skilled laparoscopic surgeons beyond the learning curve. Until now, lap aroscopic-assisted subtotal colectomy and restorative proctocolectomy do no t have the same short-term benefits as seen in other laparoscopic colorecta l procedures. Patients with inflammatory bowel disease (IBD) have a high li fe-time risk of having abdominal surgery and reoperations. The proposed adv antages of laparoscopic surgery in this group of young patients might be hi gher than in patients with other colorectal diseases. Minimal physiologic i nsult in patients who already are under significant physiologic stress, les s adhesion formation and superior cosmesis re important benefits over time. In a time where patient's demands will increase, the future of laparoscopi c colonic surgery in IBD looks assured. (C) 1998 Elsevier Science B.V. All rights reserved.