Z. Ben Safta

Laparoscopic-assisted versus conventional ileocolectomy for primary Crohn's disease: results of a comparative study.

INTRODUCTION The laparoscopic approach is becoming the gold standard in the surgical treatment of primary Crohns disease. The aim of this study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohns disease. METHODS We conducted a non-randomized, comparative, retrospective analysis of a prospective database from 1998 to 2010. The remaining 129 patients were divided into two groups: laparoscopic-assisted group (Group L; n=64) and conventional group (Group C; n=65). There were no differences between the two groups as regards preoperative patient characteristics. Complications were graded according to the Clavien-Dindo classification. RESULTS One hundred and seventeen (90.7%) patients had no complications. Out of 12 patients (9.3%) with complications, four (3.1%) had Grade I, six (4.7%) had Grade II and two (1.6%) had Grade III. There were no postoperative deaths (Grade V). Operating time was longer in Group L compared with Group C (P<0.001). Bowel function returned more quickly in the laparoscopic group in terms of return of bowel movements (P=0.018) and resumption of a regular diet (P=0.06). The mean length of stay was significantly shorter in the laparoscopic group (P=0.001). The mean follow-up was 26 months in Group L versus 34 months in Group C (P=0.06). During follow-up, six patients presented with small bowel obstruction in Group C, which was not statistically different from Group L (3 patients) (P=0.25). During the follow-up period, there have been no recurrences of Crohns disease in the laparoscopic group while 11 patients (16.9%) have developed a recurrence in the conventional group (P=0.001). CONCLUSION Laparoscopic-assisted ileocolectomy for primary Crohns disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohns disease should be considered as the preferred operative approach for primary resections.