Introduction: Data on outcomes of laparoscopic colectomy (LC) in patients with Crohn's disease (CD) colitis are limited. The purpose of this study was to compare short and long terms outcomes of LC with open colectomy (OC) in patients with CD confined to the colon.
Methods: We reviewed all patients undergoing LC for CD at our institution between 1994 and 2005. LC cases were matched to OC by patient age (+/- 5 years), gender, ASA classification, type of surgery and year of surgery (+/- 3 years). We excluded patients with concomitant small bowel disease. Data collected included BMI, co-morbidities, smoking status, disease duration, medication use, operative time, EBL, morbidity and mortality, time to bowel function, length of hospital stay, CD recurrence, re-operations and readmissions. Chi-square and Fisher exact test were use for categorical data, Wilcoxon rank sum test to quantitative data and log-rank tests were used to compare Kaplan-Mayer estimates for recurrence time.
Results: Twenty seven LCs were matched with 27 OCs. Each group included 7 segmental colectomies, 1 low anterior resection, 10 total colectomies with ileorectal anastomosis, 4 total colectomies with end ileostomy, 4 total proctocolectomies with end ileostomy, and 1 proctocolectomy with ileal-pouch rectal anastomosis. Thirty patients were males (56%) and there were seven conversions (26%). Median BMI was comparable (24 LC vs. 25 OC; P = 0.2). There was no mortality. Median operative times were significantly longer after LC (240 min vs. 150 min OC, P<0.01) and EBL was comparable (330ml LC vs. 400ml OC, P=0.3). Postoperative complications occurred in 7 LC patients vs. 9 OC (26% vs. 33%, respectively; P=0.5). One LC vs. 4 OC patients were readmitted (4% LC vs. 11% OC, respectively; P=0.6). Median time to first bowel movement was 3 days for LC vs. 4 days for OC (P=0.4), and median length of stay were comparable (6 days for each group; P=0.4). When patients with complications were excluded, median hospital stay was 5 days for LC vs. 6 days for OC (P=0.1). Recurrent CD requiring surgery was non-significantly decreased after LC (1 case vs. 9 cases after OC, 4% vs. 40%, respectively, P=0.06), although median follow-up was significantly longer after OC (12 vs. 40 months; P=0.02).
Conclusion: Laparoscopic colectomy is a safe and acceptable option for patients with CD colitis. Longer follow-up is needed to accurately establish recurrence rate when compared to OC.