Dr. Eric Dozois discusses the surgical management of Crohn’s disease
and a minimally invasive surgical procedure for Crohn’s disease.
A recent publication from the journal Surgical Endoscopy
Safety, feasibility, and short-term outcomes of laparoscopically assisted primary ileocolic resection for Crohn’s disease
ABSTRACT
Background Outcomes of laparoscopic resection for ileocecal Crohn’s disease have been reported previously in smaller studies, suggesting its short-term advantages over open surgery. This study assessed the safety and recovery parameters in the largest, consecutive, single-institution series to date.
Methods Consecutive patients undergoing laparoscopically assisted primary ileocolic resection for Crohn’s disease between 1994 and 2006 were identified in an institutional prospectively collected database. Operative and postoperative outcomes at 30 days were studied.
Results In this study, 109 patients (35 men) with a mean age of 35 ± 14 years and a mean body mass index (BMI) of 25 ± 6 kg/m2 were identified. The main indications for surgery were medically refractory disease (63%) and fibrous stenosis (27%). In 41% of the cases, previous abdominal surgery had been performed. The surgery had a mean duration of 150 ± 45 min and a conversion rate of 6%. The overall 30-day morbidity rate was 11%, and the reoperation rate was 1%. The mortality rate was 0%. The median postoperative hospital stay was 4 days (range, 2-15 days).
Conclusions This series, the largest reported to date, concurs with recent metaanalyses findings that laparoscopically assisted primary ileocecal resection for Crohn’s disease is safe and feasible, resulting in better short-terms outcomes than open resection. This operation is therefore the procedure of choice for Crohn’s disease at our institutions.
Authors
Mattias Soop, David W. Larson, Kishore Malireddy, Robert R. Cima, Tonia M. Young-Fadok, Eric J. Dozois all from Mayo Clinic
Were the anastamoses stapled or hand sewn?
Recently my side to side stapled anastamoses have leaked.
Almost all anastomosis are stapled with a 100 GIA stapler in a side-to-side functional end-to-end fashion, unless the tissue quality is poor. Then they are hand-sewn end-to-end. Leaks rates may be higher if patients are malnourished, immunosuppressed, or if there is poor blood supply. – Eric Dozois, M.D.