Minimally Invasive Surgery in Crohn’s Disease Patients

Abstract

Crohn’s disease patients are good candidates for minimally invasive (MI) surgery. This is primarily due to the benign nature of Crohn’s disease and the fact that the majority of patients are young and seek cosmetically acceptable outcomes. However, laparoscopic surgery in this cohort is technically challenging due to the inflammatory state of the bowel. A considerable number of case-control studies have demonstrated the short-term benefits of laparoscopic ileocolic resection. Recently, the technical feasibility and safety of MI surgery in patients with complex or recurrent Crohn’s disease has been reported by experienced surgeons. The presence of an intra-abdominal abscess or fistula, recurrent surgery, high dose of steroid administration, extracecal colonic disease, and malnutrition are factors associated with conversion to an open procedure. There are several technical pearls for laparoscopic colectomy for Crohn’s disease that improve the ease of the procedure. Most surgical procedures, including total proctocolectomy, can be performed safely in Crohn’s disease patients. However, with the exception of ileocolic resection, randomized controlled trials are needed to prove the short- and long-term benefits of MI surgery.