Abstract
The objective of this study was to evaluate the possibility to undertake an ileocolic resection in complex Crohn's disease using a minimal open abdominal access using standard laparoscopic instruments. The incision was carried out over the previous McBurney scar, with a mean length of 6 cm. Seventy-two patients with complicated Crohn's disease underwent IC resection in the considered period; 12 patients had a McBurney scar due to a previous appendectomy and represented the group of study. Feasibility and safety of the procedure were evaluated. Clinical data and outcome were compared with a control arm of 15 patients who had a standard laparoscopic IC resection, pooled out from our database among those who had a McBurney incision as service incision. Mean operative time and postoperative stay were significantly shorter in the study group. Blood loss and operative costs were also lower in the study group but did not reach statistical significance. Minimal open access ileocolic resection (MOAIR) through a small McBurney incision seems safe and feasible in complex Crohn's disease. Some advantages over standard laparoscopic surgery could be found in surgical outcomes and costs.
Highlights
Laparoscopy is the preferred surgical approach for ileocolic (IC) resection in Crohn’s disease (CD) when appropriate expertise is available [1, 2]
Despite the increasing evidence of its safety and efficacy, concerns have been raised about its widespread feasibility especially in patients with previous abdominal surgery and in more complex cases, where high conversion rates are still reported even in high volume referral centers [5]
The control group was made of 15 patients with similar demographic and clinical characteristics who underwent a standard laparoscopic IC resection with the service access through the McBurney incision
Summary
Laparoscopy is the preferred surgical approach for ileocolic (IC) resection in Crohn’s disease (CD) when appropriate expertise is available [1, 2]. It was first reported by Milson et al in 1993 [3], and since gained popularity and acceptance even for complex cases [1, 4]. Despite the increasing evidence of its safety and efficacy, concerns have been raised about its widespread feasibility especially in patients with previous abdominal surgery and in more complex cases (perforating or recurrent CD), where high conversion rates are still reported even in high volume referral centers [5]. In patients with previous abdominal surgery, it is often convenient to use the existing scar as the preferred service incision. MOAIR is compared with our standard laparoscopic approach in a similar group of patients to find differences in the outcome
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