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Background: Patients undergoing abdominal surgery for Crohn’s disease are predisposed to recurrence requiring reoperation. The effectiveness of laparoscopic vs. open resection in patients with previous intestinal resection for Crohn’s through a midline laparotomy is controversial.
Methods: Patients with previous open resection for intestinal Crohn’s disease undergoing elective laparoscopic surgery for recurrent bowel disease from 1997-2011 were case-matched with open counterparts based on age (±5 years), gender, body mass index (±2 kg/m2), ASA score, surgical procedure and year of surgery (±3 years).Groups were compared using chi-square or Fisher exact tests for categorical and the Wilcoxon rank sum test for quantitative data.

Results:26 patients undergoing laparoscopic ileocolectomy (n=14), proctocolectomy (n=5), small bowel resection (n=4), abdominoperineal resection (1), extended right colectomy (1) and stricturoplasty (n=1) were well-matched to 26 patients undergoing open surgery. The number of previous operations, steroid use, and incidence of hypertension, diabetes, cardiopulmonary, neurological, renal and hepatic comorbidities were comparable in the 2 groups. There were no deaths and 3 patients (12%) required conversion because of adhesions. Laparoscopic and open groups had statistically similar operating times (169±83 vs. 158±42 minutes, p=0.94), estimated blood loss (222±181 vs. 427±589 ml, p=0.32), overall morbidity (39% vs. 69%, p=0.051), reoperation rates (8% vs. 0, p=0.5), postoperative return to bowel function (3.5±1.4 vs. 3.9±1.7 days, p=0.3), mean length of hospital stay (6.4±6.2 vs. 6.9±3.5 days, p=0.12) and readmission rates (8% vs. 12%, p=0.64). Wound infection rate was decreased after laparoscopic surgery (0 vs. 27%, p=0.01).
Conclusions: Bowel resection for recurrent Crohn’s disease in patients with previous primary resection through laparotomy can be frequently and safely completed laparoscopically. Wound infection rates are reduced but there are no clear recovery advantages when compared with open surgery. The decision to operate laparoscopically should therefore be carefully calibrated.