Laparoscopic Ileocolic Resection Research Articles

Single-Incision Laparoscopic Surgery for Ileocolic Resection in Crohn's Disease

Single-incision laparoscopic surgery is a development in the field of minimally invasive surgery that is being increasingly used for colorectal procedures. We report on the short-term results of single-port laparoscopic ileocolic resection in patients with ileocecal Crohn's disease. This investigation is a retrospective matched-pair control study. Data were obtained from a prospectively maintained single-institution inflammatory bowel disease database. This study was conducted at a tertiary care university hospital. Twenty consecutive patients receiving elective single-port ileocolic resection between April 2010 and May 2011 were included (6 male, 14 female; age, 31.6 ± 10.8 years; BMI, 21.5 ± 2.6 kg/m). Their data were compared with the data of 20 individually matched patients who had undergone standard 3-trocar laparoscopic-assisted ileocolic resection between 2007 and 2010 (6 male, 14 female; age, 31.7 ± 10.7 years; BMI, 21.2 ± 2.5 kg/m). All patients had medically refractory stenosis of the terminal ileum in histologically confirmed Crohn's disease. Single-port laparoscopic-assisted or standard laparoscopic-assisted ileocolic resection was performed. The primary outcomes measured were the surgical details and early outcome. : The mean length of the paraumbilical single-port incision was 3.8 cm (range, 2.5-5.0 cm). Conversion rates were similar in both groups (1/20 vs 2/20, p = 0.55). Additional strictureplasties or short-segment small-bowel resections were performed in both groups. The overall complication rate was 20% (4/20) in both groups. There were no observed differences in postoperative pain scores and hospital stay duration. The limitations of this study were as follows: this study was a comparison of 2 different time points with possible selection bias, there was no prestudy power calculation, and the study might be underpowered. Single-port ileocolic resection is a safe procedure for the surgical treatment of stenotizing Crohn's disease of the terminal ileum. Avoidance of additional trocars was the only identified benefit.

Laparoscopic surgery for recurrent ileocolic Crohn’s disease is as safe and effective as primary resection

The safety and short-term outcome of laparoscopic surgery for recurrent ileocolic Crohn's disease was compared with the outcome following primary resection. Between June 2002 and June 2010, 59 consecutive unselected patients (30 of whom had recurrent disease) underwent laparoscopic ileocolic resection. Four primary resections and one revision were performed as a single incision laparoscopic surgery (SILS) procedure. There was no difference between the two groups in terms of age, body mass index, American Society of Anesthesiology (ASA) grade or the presence or absence of fistulating disease. The median operating time was significantly longer for the revision group (125 min vs 85 min; P < 0.001). The rate of conversion was 8.5%, morbidity was 20% and mortality was 0% (P = not significant between groups). Risk factors for conversion included a complex fistula, fibrosis and the need to carry out multiple stricturoplasty. Patients in whom surgery was converted had a longer hospital stay and a higher morbidity (40%). The median hospital stay was 3 days, the return to theatre rate was 5% and the re-admission rate was 5% (P = not significant between groups). Laparoscopic surgery for recurrent ileocolic Crohn's disease is safe and can lead to significant short-term benefit, including earlier discharge. Conversion increases the length of stay in hospital and the overall morbidity.

Laparoscopic Treatment of Presumed Perforated Appendicitis in Consecutive Patients

The aim of the present study was to determine whether the laparoscopic approach is effective in the prompt diagnosis and treatment in consecutive patients with presumed perforated appendicitis. Over a period of 2 years, 203 patients were tentatively diagnosed with perforated appendicitis on the basis of radiological findings. We performed laparoscopic procedure and evaluated the outcomes, including the incidence of alternative pathologies. Most patients (188/203, 92.6%) were treated with laparoscopic appendectomy or partial cecectomy. Five (2.4%) cases were converted to open surgery. Alternative pathologies were found in 24 patients (12%). Of these, 8 patients underwent laparoscopic ileocolic resection (4 diverticulitis, 2 Crohn disease, 1 cystadenoma, and 1 tuberculosis) and 4 patients (2 carcinoid tumors and 2 cancers) underwent subsequent laparoscopic right hemicolectomy. Complications developed in 23 patients (11.3%). Laparoscopy for presumed perforated appendicitis is an effective treatment and avoids the delay arising from a late diagnosis.

Can Laparoscopic Ileocolic Resection be Performed with Comparable Safety to Open Surgery for Regional Enteritis: Data from National Surgical Quality Improvement Program

Can Laparoscopic Ileocolic Resection be Performed with Comparable Safety to Open Surgery for Regional Enteritis: Data from National Surgical Quality Improvement Program

Can Laparoscopic Ileocolic Resection be Performed with Comparable Safety to Open Surgery for Regional Enteritis: Data from National Surgical Quality Improvement Program

Laparoscopic ileocolic resection is feasible for Crohn's disease but few studies adjust for the various preoperative, intraoperative, and postoperative variables that may confound comparisons with open surgery. The aim of this study is to compare outcomes after laparoscopic (LICR) and open ileocolic resection (OICR) performed for regional enteritis using National Surgical Quality Improvement Program (NSQIP) data. Retrospective evaluation of data prospectively accrued into the NSQIP database for patients undergoing ileocolic resection for Crohn's by LICR and OICR was performed. LICR (n = 104) and OICR (n = 203) groups had similar age (P = 0.1), body mass index (P = 0.9), smoking history (P = 0.6), steroid use (P = 0.7), diabetes (P = 0.3), serum albumin (P = 0.07), and American Society of Anesthesiologists class (P = 0.13). LICR group had more female patients (P = 0.005). Complications including surgical site infections (P = 0.5), wound dehiscence (P = 1), pneumonia (P = 0.1), deep vein thrombosis (P = 0.3), pulmonary embolism (P = 1), urinary infection (P = 0.1), and return to the operating room (P = 0.2) were similar. LICR had shorter length of hospital stay than OICR (P < 0.001). In current practice, as observed with the NSQIP data, LICR, performed by experienced surgeons, is comparable in safety to OICR and is associated with a shorter hospital stay.

Video-assisted versus open ileocolic resection in primary Crohn’s disease: a comparative case-matched study

Despite the technical difficulties, laparoscopic ileocolic resection for Crohn's disease (CD) has become widely accepted in recent years, due to its potential benefits. There are numerous reports concerning the use of laparoscopy in successfully treating CD, including two randomized trials and few comparative studies. For the most part, these reports outline use of laparoscopic approach in primary distal ileal or ileocolic disease, with a careful selection of the patients. The purpose of this comparative case-control study was to point out potential advantages and disadvantages in short- and long-term outcomes of the laparoscopic approach compared with the open one. From January 1999 to January 2004, 200 patients were admitted in our Surgical Unit for complicated primary CD. 100 patients (group 1) underwent a laparoscopic ileocolic resection, 100 patients (group 2), with alike demographic and clinical characteristics, underwent the same procedure using a traditional approach. The incidence of perforative disease was 32 and 40% in groups 1 and 2, respectively. Average operative time was 140min (range 90-245min) in the video-assisted group and 98min (range 65-255min) in group 2 (P<0.05). Postoperative morbidity was 6 and 8% in groups 1 and 2, respectively (P=NS). Recovery of peristalsis occurred within 2-3days in group 1 and 3-4days in group 2 (P=NS). Median postoperative hospitalization was 7days (range 5-18days) in group 1 and 9days (range 7-22days) in control group (P<0.05). The overall rate of surgical relapse of CD was 8 and 13% in groups 1 and 2, respectively (P=NS), at a mean follow-up of 52 and 60months, respectively. The 1-year surgical recurrence rate was similar (3%) for the two groups. In conclusions, in spite of the technical difficulties, video-assisted surgery for CD offers advantages over laparotomy, including less postoperative pain, reduced postoperative hospital stay, less disability of the patient, and better cosmetic results. Potential advantages are: easier approach for re-resection, lower rate of postoperative adhesions and bowel obstruction, and lower rate of wound complications.

Laparoscopic resection with transcolonic specimen extraction for ileocaecal Crohn's disease

Ileocolic resection for Crohn's disease can be performed entirely laparoscopically. However, an incision is needed for specimen extraction. This prospective observational study assessed the feasibility of endoscopic transcolonic specimen removal. Endoscopic specimen removal was attempted in a consecutive series of ten patients scheduled for laparoscopic ileocolic resection. Primary outcomes were feasibility, operating time, reoperation rate, pain scores, morphine requirement and hospital stay. To assess applicability, outcomes were compared with previous data from patients who had laparoscopically assisted operations. Transcolonic removal was successful in eight of ten patients; it was considered not feasible in two patients because the inflammatory mass was too large (7-8 cm). Median operating time was 208 min and median postoperative hospital stay was 5 days. After surgery two patients developed an intra-abdominal abscess, drained laparoscopically or percutaneously, and one patient had another site-specific infection. The operation took longer than conventional laparoscopy, with no benefits perceived by patients in terms of cosmesis or body image. Transcolonic removal of the specimen in ileocolic Crohn's disease is feasible in the absence of a large inflammatory mass but infection may be a problem. It is unclear whether the technique offers benefit compared with conventional laparoscopic surgery.

Nonoperative management of right colonic diverticulitis using radiologic evaluation

Although a few reviews have been conducted, nonoperative management may be the mainstay of therapy for uncomplicated right colonic diverticulitis. With increasing use of radiological evaluation for diverticulitis, the status of the disease is becoming more accessible. In this study, clinical outcomes of nonoperative management for right colonic diverticulitis were assessed according to disease status using radiological evaluation. From April 2000 to March 2007, 296 patients were admitted for acute right colonic diverticulitis upon first attack and were treated with nonoperative management. The status of diverticulitis was classified using ultrasonography and/or computed tomography as inflamed diverticulum or phlegmon in 276 patients or pericolic abscess in 20 patients. Uncomplicated diverticulitis was defined as inflamed diverticulum or phlegmon. Length of hospital stay, antibiotic use, failure of initial therapy and the incidence of recurrence after nonoperative management were assessed. The mean length of hospital stay and antibiotic use were 6 and 4.7 days respectively. All patients were successfully treated with the initial medical therapy and their hospital stays were uneventful. Of the 276 patients with an uncomplicated diverticulitis, two patients (1%) had a recurrence during follow-up that could be managed nonoperatively. Of the 20 patients with pericolic abscesses, four patients (20%) had a recurrence. One patient underwent laparoscopic ileocolic resection and the other patients were treated nonoperatively. Nonoperative management may be the treatment of choice for right colonic diverticulitis with inflamed diverticulum or phlegmon. Diverticulitis with pericolic abscess should be treated with additional care.

Laparoscopic Intracorporeal Ileocolic Resection for Crohn's Disease

The aim of this study was to assess the impact of laparoscopic ileocolic resection with intracorporeal vascular division and anastomosis on the outcome of patients with terminal ileal Crohn's disease. Prospective data on patients undergoing laparoscopic ileocolic resection for Crohn's disease confined to terminal ileum and cecum with or without fistulas were reviewed. Exclusion criteria were frozen abdomen, recurrent Crohn's disease following resection, and perforated Crohn's disease. Laparoscopic ileocolic resection involved a lateral-to-medial approach encompassing ten sequential steps. Values were medians (range). From January 1992 to June 2006, 80 laparoscopic ileocolic resections were attempted with a 1.2 percent conversion rate. Sixty-two women and 18 men, age 40 (19-55) years, had a body mass index of 26 (18-37) and an American Society of Anesthesiologists' score of 1 (1-3), and 23.7 percent had previously undergone abdominal surgery. Operating time was 155 (130-210) minutes. Estimated blood loss was 250 (50-600) ml. Length of the skin incision at the specimen extraction site was 35 (30-44) mm. The complication/reoperation rate was 7.5 percent. The readmission rate was 3.7 percent. Except for smoking (P < 0.005), there were no significant differences between patients with and those without complications. The recurrence rate was 30 percent (24 of 80). The median time to recurrence was 64 months. Laparoscopic ileocolic resection with intracorporeal vascular division and anastomosis resulted in a favorable outcome in selected patients with refractory terminal ileal Crohn's disease.

Endoscopic Transcolonic Specimen Removal in Laparoscopic Ileocolic Resection for Crohn's Disease: Initial Experience

Background: Ileocolic resections for Crohn's disease can be done entirely laparoscopically, including devascularisation, transsection and reanastomosing. The only reason to perform a minilaparotomy is to remove the specimen. Aim: To assess feasibility of endoscopic transcolonic specimen removal obviating the need for minilaparotomy. Materials and Methods: In a consecutive series of patients scheduled for laparoscopic ileocolic resection, endoscopic transcolonic specimen removal was attempted. Primary outcome parameters were success rate, operating time, complication rate, length of stay and postoperative pain scores. Results: From February to September 2008, 10 patients (seven women and three men with a median age of 31) were included. A 4-trocar approach was used. The right colon was mobilized and the mesentery was devascularised close to the bowel using ultrasonic dissection to minimize specimen diameter. Large bowel and ileum were transsected using endoscopic staplers. After bowel division, the endoscopist introduced a colonoscope up to the area of bowel transsection. When it reached the cross stapled large bowel, terminal ileum and large bowel were opened to introduce a stapler. The small bowel was clamped to avoid spillage. Using an endostapler a side to side anastomosis was created. Next, the endoscope was advanced through the remaining gap in the anastomosis, grasping the specimen using an endoscopic snare. During endoscopic removal of the specimen, the laparoscopist facilitated passage of the specimen through the anastomosis for transcolonic retrieval. After this the remaining anastomotic gap was sutured laparoscopically. In two patients with a large inflammatory mass, transcolonic removal was considered not feasible. Overall success rate therefore was 80%. Median operating time was 208 minutes (range 157-327). Median length of resected bowel segment was 25.5 cm (range 16-64), median postoperative hospital stay 5 days (range 2-10). One patient developed a Douglas abscess which was drained laparoscopically. One of the patients in which transcolonic removal was considered not possible developed a sub hepatic abscess that was drained percutaneously. Pain scores decreased quickly after surgery from 3.8 at day one to 0.5 after 28 days. Conclusion: With a success rate of 80%, transcolonic removal of the specimen in ileocolic Crohn's disease is feasible in absence of an inflammatory mass. It is associated with a fast postoperative recovery. It is however questionable whether the increased complexity of the technique and time consuming logistics are justified by the potential benefit for patients when compared to conventional laparoscopic techniques.

14 - Clinical course and cost of care in ulcerative colitis: Markov chain analysis of a European prospective population-based cohort

14 - Clinical course and cost of care in ulcerative colitis: Markov chain analysis of a European prospective population-based cohort

P134 - Transcolonic specimen removal in laparoscopic ileocolic resection for Crohn's disease: initial experience

P134 - Transcolonic specimen removal in laparoscopic ileocolic resection for Crohn's disease: initial experience

Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: Follow-up of a prospective randomized trial

Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: Follow-up of a prospective randomized trial

Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn's disease: a randomized multicenter trial (LIR!C-trial)

BackgroundWith the availability of infliximab, nowadays recurrent Crohn's disease, defined as disease refractory to immunomodulatory agents that has been treated with steroids, is generally treated with infliximab. Infliximab is an effective but expensive treatment and once started it is unclear when therapy can be discontinued. Surgical resection has been the golden standard in recurrent Crohn's disease. Laparoscopic ileocolic resection proved to be safe and is characterized by a quick symptom reduction.The objective of this study is to compare infliximab treatment with laparoscopic ileocolic resection in patients with recurrent Crohn's disease of the distal ileum with respect to quality of life and costs.Methods/designThe study is designed as a multicenter randomized clinical trial including patients with Crohn's disease located in the terminal ileum that require infliximab treatment following recent consensus statements on inflammatory bowel disease treatment: moderate to severe disease activity in patients that fail to respond to steroid therapy or immunomodulatory therapy. Patients will be randomized to receive either infliximab or undergo a laparoscopic ileocolic resection. Primary outcomes are quality of life and costs. Secondary outcomes are hospital stay, early and late morbidity, sick leave and surgical recurrence. In order to detect an effect size of 0.5 on the Inflammatory Bowel Disease Questionnaire at a 5% two sided significance level with a power of 80%, a sample size of 65 patients per treatment group can be calculated. An economic evaluation will be performed by assessing the marginal direct medical, non-medical and time costs and the costs per Quality Adjusted Life Year (QALY) will be calculated. For both treatment strategies a cost-utility ratio will be calculated. Patients will be included from December 2007.DiscussionThe LIR!C-trial is a randomized multicenter trial that will provide evidence whether infliximab treatment or surgery is the best treatment for recurrent distal ileitis in Crohn's disease.Trial registrationNederlands Trial Register NTR1150

Surgery Insight: minimally invasive surgery for IBD

The most frequently described laparoscopic operations for the management of patients with IBD are restorative proctocolectomy for ulcerative colitis and ileocolic resection for Crohn's disease. For patients with Crohn's disease, there is level 1b evidence that, in experienced hands, laparoscopic ileocolic resection enhances recovery and leads to a shorter hospital stay compared with conventional ileocolic resection. The demonstrated advantages of laparoscopic ileocolic resection with regard to cost and cosmesis, and the acceptable long-term results achieved (which are at least comparable to those achieved by conventional ileocolic resection) favor the use of laparoscopic ileocolic resection over conventional ileocolic resection in patients with ileocolic Crohn's disease. For patients with ulcerative colitis, the expected advantages of laparoscopic restorative proctocolectomy over conventional restorative proctocolectomy have yet to be clearly shown. Although there is a trend towards a reduced hospital stay (of only 1.6 days) when laparoscopic restorative proctocolectomy is performed, operating times are disproportionably prolonged. The most important argument for offering patients with IBD the chance to undergo a laparoscopic procedure, rather than conventional open surgery, is (particularly for women) the long-term superior cosmesis and body image it confers.

Is There Any Difference in Recurrence Rates in Laparoscopic Ileocolic Resection for Crohn's Disease Compared With Conventional Surgery? A Long-Term, Follow-Up Study

The long-term outcome of laparoscopic ileocolic resection in patients with Crohn's disease is not well defined. This study was designed to define the surgical recurrence rate after laparoscopic ileocolic resection for Crohn's disease and to compare it with that seen after open ileocolic resection. A retrospective review of 113 records of patients who underwent index ileocolic resection for terminal ileal Crohn's disease was performed (1987-2003). Recurrence was defined as development of new preanastomotic Crohn's disease requiring surgical intervention. Details of recurrence and use of chemoprophylaxis was determined by phone interview and chart review. Sixty-three patients (26 males; mean age, 35.2 years) underwent laparoscopic ileocolic resection and 50 had open ileocolic resection (17 males; mean age, 37.1 years). Surgical recurrence developed in 6 of 63 patients (9.5 percent) in the laparoscopic ileocolic resection group (mean follow-up, 62.9 months) and in 12 of 50 patients (24 percent) in the open ileocolic resection group (mean follow-up, 81.8 months). Rates of chemoprophylaxis were similar between groups (laparoscopic ileocolic resection, 39 percent; open ileocolic resection, 54 percent; P = not significant). Median times to recurrence after laparoscopic ileocolic resection and open ileocolic resection were 60 (range, 36-72) months and 62 (range, 12-180) months, respectively. Fifty percent of the recurrences in the laparoscopic ileocolic resection group and 4 of 12 in the open ileocolic resection group were able to be retreated laparoscopically. Re-recurrence occurred in 4 of 12 open ileocolic resection patients (33 percent) at a mean of 63.6 months, and one patient had a third recurrence at 28 months. In this study, the long-term outcome after laparoscopic ileocolic resection was not shown to be statistically different from that of open ileocolic resection. The relatively low recurrence rates in both groups may be explained by our aggressive use of chemoprophylaxis.

Total intracorporeal laparoscopic resection of Crohn's disease

Background/Purpose: The benefits of laparoscopic resection for Crohn's disease have been well established in the adult literature. This modality more recently has been applied to children. The authors report their experience in this age group. Methods: A prospective series of all pediatric Crohn's patients treated laparoscopically in one surgical practice was studied for demographic data, operative details, and outcome. Results: Fifteen patients with diagnosis of Crohn's disease, ages 9 to 17 years, underwent laparoscopic ileocolic resection between February of 1998 and 2002. Patients' weights ranged from 42 to 80 kg. All patients had fixed strictures involving the terminal ileum and ileocecal valve and had failed medical therapy. A 4-port approach (one 12-mm and 3 5-mm) was utilized in all cases. Resection and anastomosis was performed intracorporeally, and the specimen was retrieved through the 12-mm port site. The average operating time was 110 minutes (range, 90 to 180 minutes). Oral feedings were started after 24 hours of nasogastric suction. Hospital stay averaged 4 days (range, 3 to 8 days). One patient had a fever on postoperative day 3. Contrast study showed a small anastomotic leak with no associated collection, and the patient responded to conservative management. One other patient whose pathologic diagnosis questioned the initial Crohn's diagnosis presented with an anastomotic stricture and underwent redo resection laparoscopically with good outcome. No other complications were noted, and all patients were symptom free at follow-up. Conclusions: Laparoscopic resection of Crohn's disease in children is safe and effective. J Pediatr Surg 38:717-719. © 2003 Elsevier Inc. All rights reserved.

Influence of experience on laparoscopic ileocolic resection for Crohn's disease.

The technical difficulties that are frequently encountered in surgery for Crohn's disease have led some authors to suggest Crohn's cases should not be attempted early in one's laparoscopic colorectal surgery experience. This article reviews one surgeon's experience with laparoscopic terminal ileal resections for Crohn's disease to assess the safety of beginning laparoscopic colorectal resections with these procedures. A retrospective review of all laparoscopic ileocolic resections performed by a single surgeon was performed. Sixty-nine (82 percent) of 84 procedures were completed laparoscopically. Reasons for conversion were dense adhesions (n = 5) and complex masses (n = 10). The mean operating time for the entire group was 145 +/- 39 (range, 87-289) minutes. Postoperative length of stay was 5.6 +/- 2.4 (range, 2-21) days. The mean incision length in the laparoscopic group was 4.5 +/- 1.15 cm. If the series is examined in three equal intervals, the number of patients with multiple difficulties (abscess, fistula, and previous resection or mass) increased in the final part of the study, without affecting complication or conversion rates. Despite the increased case complexity, average length of stay was significantly reduced between the second and third time periods (P = 0.008). Despite its technical demands, laparoscopic ileocolic resection was a safe procedure with potential advantages to patients. Laparoscopic resection is possible in the vast majority of patients with ileocolic Crohn's disease, regardless of the nature of the pathology. Previous resections, abscesses, fistulas, and phlegmons do not preclude success, although these cases should likely not be the first attempted.

Advantages of laparoscopic resection for ileocolic Crohn's disease. Improved outcomes and reduced costs.

Laparoscopic colorectal procedures are considered to be technically challenging, and there is a lack of consensus regarding the magnitude of their benefits. The laparoscopic approach is generally held to be more expensive. Using a model of a single procedure performed for a single indication (ileocolic resection for Crohn's disease [CD]), we set out to demonstrate the feasibility of this procedure by determining the conversion rate, documenting the patient benefits, and performing a formal cost analysis. Consecutive cases of laparoscopic ileocolic resection for CD were identified (LAP). Case-match methodology identified a series of open laparotomy controls (OPEN) that were matched for five potential confounding criteria: age, gender, diagnosis, type of resection, and date of operation. Pre-, intra-, and postoperative details were gathered. Medical resource utilization was tracked using a standardized database, and all costs were reported in 1999 dollars. The conversion rate was 5.9%. Resolution of ileus occurred more rapidly in the LAP than in the OPEN group. The time to clears in the LAP group was a median of 0 days (range, 0-4) vs 3.0 days (range, 2-8) in the OPEN group (p = 0.0001). Time to regular diet was 2.0 days (range, 1-6) in the LAP group vs 5.0 days (range, 3-12) in the OPEN group (p = 0.0001). Length of hospital stay was significantly reduced in the LAP group (4.0 days [range, 2-8], vs 7.0 days [range, 3-14], p = 0.0001). The LAP group had significantly lower direct costs ($8684 vs $11,373) and indirect costs ($1358 vs $2349) than the OPEN group (p < 0.001). This resulted in total costs of $9895 for LAP vs $13,268 for OPEN (p < 0.001). Laparoscopic ileocolic resection for CD is feasible. There are significant postoperative benefits in terms of resolution of ileus, narcotic use, and hospital stay. This approach translates into cost savings of >$3300 for laparoscopic patients.

Laparoscopically assisted bowel surgery for inflammatory bowel disease. The combined experiences of two academic centers.

Laparoscopic bowel surgery was evaluated in 44 consecutive patients who underwent surgery for inflammatory bowel disease (IBD). We studied feasibility, results, and final outcome. At two academic institutes, 44 laparoscopically assisted colectomies and laparoscopic ileostomies or colostomies were attempted. All patients had histologically proven IBD and no prior surgery for IBD. Loop ileostomy (n = 4), end colostomy (n = 1), ileocecal resection (n = 26) and (procto)colectomy (n = 13) were performed. All resections were laparoscopically assisted with extracorporal resection and anastomosis. Only in two patients (ileocecal resection in both) was conversion to open surgery necessary. Two patients with laparoscopic ileocolic resection had intra-abdominal abscesses, which were drained percutaneously in both. One patient in the laparoscopically assisted colectomy group had a subphrenic abscess that was drained percutaneously, and one patient had a generalized candidiasis. Laparoscopically assisted colectomies can be performed safely in treating IBD. The laparoscopic method with use of a small vertical umbilical or Pfannenstiel's incision seems acceptable with regard to operating time and overall costs, also allowing superior cosmesis to be maintained.