Complication Rates After Bowel Resections for Crohnʼs Disease: A Brazilian Single-Center Comparison Between Laparoscopic And Conventional Surgery

Abstract

Significant advances in medical therapy for Crohn's disease (CD) occurred in the last 12 years, mainly due to the introduction of anti-TNF therapy. Laparoscopic colorectal surgery represented the most important advance on surgical treatment in the management of CD, as it also had developed in the treatment of other conditions. The advantages of the laparoscopic procedures, such as shorter hospital stay, lower bleeding and better cosmesis were also noticed in resections for CD. There is a tendency for lower complication rates after laparoscopic bowel resections as compared to open surgery. The aim of this study was to analyze and compare the complication rates after bowel resections for CD between the two approaches in a Brazilian case series. This is a retrospective longitudinal study, including CD patients submitted to bowel resections from a single Brazilian Inflammatory Bowel Diseases (IBD) referral center, treated between January 2008 and June 2012, with laparoscopic surgery (LS) or conventional surgery (CS). A review of electronic charts was performed, with a specific protocol. Variables analyzed: age at surgery, gender, Montreal classification, smoking, concomitant medication, type of surgery, surgical approach, presence and type of complication up to 30 days after the procedures. Complications were defined as medical (urinary tract infection, pneumonia, ileus, pancreatitis and central venous catheter infection) or surgical (abdominal abscess, fistula, anastomotic leakage and wound infection). Readmission and reoperation rates, as well as mortality, were also analyzed. Patients were allocated in two groups regarding the type of procedure (LS or CS), and complication rates and characteristics were compared. Statistical analysis was performed with Mann Whitney test (quantitative variables) and chi-square test (qualitative variables), with P < 0.05 considered significant. A total of 46 patients (25 men) were included (16 submitted to laparoscopic surgery), with mean age of 38.1 (±12,7) years. The groups were considered homogeneous according to age, gender, CD location, perianal disease and concomitant medications. There were more patients with fistulizing CD on the CS group (P = 0.029). The most common procedure performed was ileocolic resection on both groups (56.7% of the CS and 75% of the LS patients - P = 0.566). Overall, total complications (surgical and medical, including minor and major issues) occurred in 60% (18/30) of the CS group and 12,5% (2/16) of the LS group (P = 0.002). Wound infection was the most frequent complication (10/30 on CS and 1/16 on the LS groups). There were 3 deaths in the CS group. Specific analysis of each complication did not demonstrate any difference between the groups regarding abdominal sepsis, urinary tract infections, pneumonia, readmission, reoperations and deaths (P = 0.074). There was a higher complication rate in patients operated with CS as compared to LS. This was probably due to patient selection for the laparoscopic approach, with severe cases, mostly due to fistulizing abdominal CD, being operated mainly by open surgery. Randomized controlled trials can lead to better conclusions regarding this topic. However, LS tends to be the recommended approach in most cases of non-complicated CD.