Abstract
BackgroundLaparoscopic surgery for penetrating Crohn’s disease (CD) still remains highly conflicting due to a lack of sufficient data. Therefore, the following large study was designed to compare postoperative outcomes after minimal-invasive resections for penetrating and non-penetrating CD.MethodsConsecutive patients, who underwent laparoscopic intestinal resection for symptomatic CD at a tertiary academic referral center, were included. Patients were divided according to perioperative findings in penetrating and non-penetrating type of disease. All clinical data were obtained from an institutional database and analyzed retrospectively.ResultsOf 234 patients enrolled, 101 patients [females: n = 54 (53.5 %)] were operated on for non-penetrating CD and 133 patients [females: n = 50 (37.6 %)] for penetrating CD. Fistulas (p < 0.001), inflammatory mass (p < 0.001) and abscess formation (p < 0.001) were observed more frequently in the perforating group. Ileocolic resections were performed predominantly in both groups [perforating CD: n = 110 (82.7 %), non-perforating CD: n = 82 (81.2 %)], with more complex resections (>1 intestinal resection) found in perforating CD (p < 0.001). Conversion rates did not differ significantly. Notably, 30-day postoperative morbidity was comparable for both groups [perforating CD: n = 20 (15 %), non-perforating CD: n = 19 (18.8 %), p = 0.44]. Postoperative complication rates graded according to the Clavien–Dindo classification showed no difference too (p = 0.49).ConclusionLaparoscopic surgery can be conducted safely in selected patients with penetrating CD without increasing the risk of postoperative complications. This finding needs to be implemented in future guidelines.
Highlights
Background Laparoscopic surgery for penetratingCrohn’s disease (CD) still remains highly conflicting due to a lack of sufficient data
We present the largest study to date comparing outcomes of laparoscopic resection for penetrating and non-penetrating disease
Intraoperative findings were significantly different between both groups in terms of the presence of inflammatory mass [penetrating CD (PCD): n = 85 (63.9 %), nonpenetrating CD (NPCD): n = 14 (13.9 %), p \ 0.0001], fistula [PCD: n = 118 (88.7 %), NPCD: n = 0, p \ 0.0001] and abscess formation [PCD: n = 43 (32.3 %), NPCD: n = 0, p \ 0.0001]
Summary
Our aim is to treat the majority of CD patients by using a minimal-invasive approach; patients with previous laparotomies in association with penetrating disease are still often managed by laparotomy
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