Laparoscopic resection of inflammatory bowel disease

Abstract

PURPOSE: To determine the feasibility of laparoscopic resection of inflammatory bowel disease. METHODS: A retrospective chart review was performed of laparoscopic procedures for Crohn's disease (CD) or chronic ulcerative colitis (CUC). RESULTS: One hundred and forty four patients were reviewed, 89 females and 55 males, age 15 to 78 years (mean 38 years). The most common diagnosis was CD, in 128 patients, with CUC in 15 and indeterminate colitis in 1 patient. Of patients with CD, 58 (40%) had previous abdominal operations, 32 for prior resection of CD and 26 unrelated to CD. The indication for operation in CD was refractory disease in 27, and obstruction +/stricture in 39 patients; 49 patients had a preoperative diagnosis of fistula, phlegmon or abscess. There were unexpected intraoperative findings in 41 patients, with phlegmon and fistula being the most common intraoperative findings. The conversion rate for patients with CD was 20/128 or 15.6%, and 2/15 or 13% in CUC. Among the 27 patients in whom the preoperative indication was solely refractory disease, only 4 had unexpected intraoperative findings, and there were no conversions. Among those patients who had a preoperative diagnosis of obstruction +/stricture, 9 had unexpected findings at laparoscopy, and the conversion rate was 4/39 or 10%. Of those 49 patients with a preoperative diagnosis of fistula, abscess or phlegmon, the conversion rate was 14/49 or 29%, and 23 of these patients had additional unexpected findings at laparoscopy. Overall there were 8 intraoperative complications, for a rate of 5.6%. The post-operative complication rate was 17/144 or 12%; of these, 4 were wound infections, for a rate of 4/144 or 2.7%. There was no operative mortality. The mean length of stay for the whole series, including converted cases, was 5.7 days. CONCLUSIONS: The laparoscopic approach is highly feasible in CUC and in CD, with low conversion rates in the absence of preoperative findings of fistula, abscess or phlegmon. Even with a preoperative diagnosis of fistula, abscess or phlegmon, the laparoscopic approach is feasible in 70% of patients.