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Reissman, P; Salky, BA; Pfeifer, J; Edye, M; Jagelman, DG; Wexner, SD.
Laparoscopic surgery in the management of inflammatory bowel disease.
Am J Surg. 1996; 171(1): 47-50. Doi: 10.1016/S0002-9610(99)80072-5
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Co-authors Med Uni Graz: Pfeifer Johann
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Abstract:: BACKGROUND: The role of laparoscopic surgery in the treatment of various upper and lower gastrointestinal disorders is still under investigation. However, a variety of laparoscopic procedures may be applied in the treatment of inflammatory bowel disease (IBD). PATIENTS AND METHODS: We present our initial results of laparoscopic and laparoscopic-assisted management of IBD in 72 consecutive patients (37 women and 35 men; mean age 36 years, range 20 to 79). The indications for surgery included: terminal ileitis in 29 patients, mucosal ulcerative colitis in 23 patients, Crohn's colitis in 11 patients, severe perianal Crohn's disease in 4 patients, duodenal Crohn's disease in 3 patients, Crohn's rectovaginal fistula in 1 patient, and rectourethral fistula in 1 patient. The procedures performed included: total abdominal colectomy (TAC) in 30 patients (22 with total proctocolectomy with ileoanal reservoir, 6 with TAC with ileorectal anastomosis, and 2 with TAC with end ileostomy), ileocolic resection in 30 patients, diverting loop ileostomy in 6 patients, closure of an end ileostomy as an ileorectal anastomosis in 3 patients who already underwent a TAC with end ileostomy, and duodenal bypass gastrojejunostomy in 3 patients. RESULTS: There were 16 complications in 13 (18%) patients: 3 enterotomies, 4 episodes of bleeding, 3 pelvic abscesses, 2 intestinal obstructions, 2 prolonged ileus, 1 anastomotic leak, and 1 efferent loop obstruction after gastrojejunostomy. However, only 3 patients required laparotomy for morbidity, and there was no mortality. In 7 (10%) patients, the laparoscopic procedure was converted to a laparotomy due to a large inflammatory mass with fistula in 4 patients, bleeding in 2 patients, and an enterotomy in 1 patient. The mean operating time was 2.9 hours (range 0.7 to 6) and the mean length of hospital stay was 6.5 days (range 3 to 19). When compared with ileocolic resection, total colectomy was associated with higher morbidity (30% versus 10%, P < 0.05) and longer hospitalization (8.7 days [range 4 to 19] versus 5.2 days [range 3 to 7], respectively; P < 0.05). CONCLUSIONS: According to this initial experience, laparoscopic surgery is a versatile and effective modality in the surgical management of inflammatory bowel disease in selected patients. However, laparoscopic total colectomy is associated with higher morbidity when compared with ileocolic resection.
Find related publications in this database (using NLM MeSH Indexing): Adult -; Aged -; Colectomy - methods; Colitis, Ulcerative - surgery; Crohn Disease - complications; Duodenal Diseases - surgery; Female - surgery; Humans - surgery; Ileitis - surgery; Ileostomy - methods; Inflammatory Bowel Diseases - surgery; Laparoscopy - surgery; Laparotomy - surgery; Length of Stay - surgery; Male - surgery; Middle Aged - surgery; Postoperative Complications - surgery; Proctocolectomy, Restorative - methods; Rectal Fistula - surgery; Rectovaginal Fistula - surgery; Treatment Outcome - surgery; Urethral Diseases - surgery; Urinary Fistula - surgery