Laparoscopically assisted intestinal resection in 88 patients with Crohn'sdisease

Background: Experience with 94 resections in 88 patients with Crohn's disea se using advanced laparoscopic techniques is reported. Records of patients who underwent intestinal resection for Crohn's disease between August, 1993 and November, 1998 were reviewed. Indications, operative findings, clinico pathologic, and postoperative data were recorded. Methods: In this study, the mean age was 37 years (range, 16-70 years), and 55% of the participants were women. Indications for surgery included obstr uction (64 cases), pain (22 cases), peritonitis (1 case) and abscess (1 cas e). Seventy patients underwent ileocolic resection, 28 of whom had a previo us history of one or two ileocolic resections. Eight of these patients had additional procedures including tubal ligation (1), sigmoidectomy (1), chol ecystectomy (3 cases), and enterectomy (3 cases). Small bowel resection (13 cases), right hemicolectomy (3 cases), subtotal colectomy (3 cases), anter ior rectal resection (2 cases), and sigmoid resection (3 cases) were perfor med in the remaining patients. All but one procedure were completed laparos copically with extracorporeal anastomosis. The average length of intestine resected was 33 cm (range, 10-92 cm). Forty-one patients had 58 fistulae be tween ileum, jejunum, mesentery, colon, abdominal wall, skin, or bladder. M ean blood loss was 168 mi (range, 30-800 ml) and mean operative time was 18 3 min (range, 96-400 min). Results: More than 85% of the patients were tolerating a liquid diet on the first postoperative day. Average length of hospital stay was 4.2 days (ran ge, 3-11 days). Complications included anastomotic leak necessitating reope ration, stricture requiring endoscopic dilation, hemorrhage treated expecta ntly, urinary tract infection, pulmonary embolus, line sepsis, and early po stoperative intestinal obstruction (7 cases) requiring reoperation in three cases. Conclusions: Experience with both advanced laparoscopic techniques and conv entional surgery for inflammatory bowel disease allowed successful laparosc opic management of patients with complicated Crohn's disease.