MINIMALLY INVASIVE SURGERY AND CROHNS-DISEASE

Patients with Crohn's disease are operated on with a morbidity of 15% and a mortality of 0% if the indication for surgery is decided in good time. After ileocecal resection the probability of having a second re section in 15-20 years is about 50%. When elective surgery is done at an early disease stage, ileocecal resections and reoperations for anas tomotic stenosis can be performed by assisted laparoscopy assisted. La paroscopic colonic resections are done more rarely. Acute and life-thr eatening conditions such as obstruction, perforation and sepsis are ex cluded from the laparoscopic approach. In a combined series of 222 lap aroscopic resections for Crohn's disease, the following types of surge ry were included: ileocecal resections (75), anastomotic resections (2 6), small intestinal resections (4), loop ileostomies (17), gastrojeju nostomies (3), partial colonic resections (15), colectomies (16), loop colostomies (2) and one adhesiolysis. Two patients who sustained intr aoperative bleeding underwent conversion of laparotomy. The conversion rate ranged from 0 to 22%. Reasons for 32 conversions were: large inf lammatory mass (14), severe inflammation (5), fistula (3), abscess (1) , perforation (1), small intestine dilation (1) and mesenteric thicken ing (1). Mean operative time for ileocecal resections ranged from 105 to 200 min. The postoperative hospital stay was 5 to 8 days. As more e xperience is gained and technical improvement is achieved, additional procedures such as resolution of severe adhesions, fistula closure and resections of colonic segments will be offered to the majority of pat ients who require elective surgery for localized Crohn's disease.