Laparoscopic vs Conventional Ileocolectomy for Primary Crohn Disease

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Abstract
SINCE THE FIRST reports of laparoscopic surgery for inflammatory bowel disease from Peters in 1992,1 several articles in the literature have subsequently shown the potential advantages of this approach over conventional surgery. Laparoscopic surgery for other colorectal conditions, such as benign tumors, rectal prolapse, and diverticular disease, is clearly feasible and safe. The role of laparoscopic surgery in the treatment of colorectal malignancies is still under investigation. Patients with Crohn disease represent a select group of patients with specific complications (ie, strictures, fistulae) that usually require several operations throughout their lifetime to alleviate symptoms. With appropriate noninvasive evaluation, including computed tomographic scans, small bowel series, and colonoscopy, we preoperatively attempted to identify the location and size of stricture(s), fistulae, and/or abscesses. However, sometimes findings at surgery differed, despite all preoperative investigations.2 Significant laparoscopic skill and experience are usually necessary because of the fragility of the inflamed intestinal tissues, thickened mesentery, and the presence of dense adhesions, which may have been responsible for higher conversion rates in earlier series. However, several advantages are proposed, such as improved cosmesis, less pain, faster recovery, and shorter hospital stay, which make the laparoscopic approach an attractive and safe alternative to conventional surgery.3-5 The purpose of this study was to compare retrospectively the safety, outcomes, length of stay, and cost for patients with Crohn disease treated via laparoscopic vs conventional surgery during a 5-year period at an academic medical center.