Abstracts
1997 Digestive Disease Week

Laparoscopically assisted bowel resection for Crohn's disease: the best of both worlds.

MA Talamini*, RC Moesinger*, H Kaufman*, M Kutka, M Harris§, T Bayless§. Departments of *Surgery and §Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, MD.

Introduction. Crohn's disease, with its thickened mesentery, inflammatory masses, and tendency for enteric fistulae, presents unique challenges for a minimally invasive approach. Our solution to these challenges has been a "hybrid" procedure--laparoscopic intracorporeal dissection with extracorporeal anastomoses. The purpose of this study was to evaluate laparosopically assisted bowel resection (LABR) in Crohn's disease and compare the results retrospectively to a corresponding group of patients who underwent an open procedure for Crohn's disease.

Methods. From July 1993 to March 1995, 20 laparoscopically assisted bowel resections were attempted, and 17 were completed. All patients felt to be candidates were offered the procedure, and none refused. The average age was 35 years and 65% were female. The procedure consisted of mobilization of the diseased bowel using laparoscopic techniques, delivery of the bowel and mesentery through a small incision (3-5 cm), then resection and anastomosis extracorporeally (18 anastomoses in 17 patients). These patients were compared to a matched cohort of 36 control patients with Crohn's disease undergoing conventional open bowel resection (average age 34 years, 56% female). Postoperative recovery was measured using a newly developed tool, the Surgical Recovery Index (SRI) which assesses postoperative ability to perform nine common activities of daily living.

Results. Successful LABR was defined as the incision being 5 cm. or less. Type of resection and history of prior surgical procedures were similar in the two groups. Three conversions to larger incisions were necessary due to inflammatory adhesions. The patients with successful LABR were compared to the matched control patients:

           Blood     Op. Time   Bowel Fx.   Hosp.       MS†        SRI
 LABR     147 mls*   214 min.   3.7 days*   5.9 days*   159 mg*    13.1*
 Open     243 mls    207 min.   5.1 days    8.1 days    307 mg     20.3
*p<0.05 by Students t-test. †morphine equivalents.

The average length of incision for LABR patients was 3.9 cm. Previous resection for Crohn's disease (4 patients) was not predictive of failure (2 LABR, 2 open). Postoperative complications included one port site hematoma requiring transfusion and one early partial bowel obstruction resolved by nasogastric decompression.

Conclusion. We conclude that LABR is a safe and effective means of bowel resection for patients with Crohn's disease. Retrospective comparison demonstrates no difference in operative time, as well as less pain, reduced hospital stay, less blood loss, and earlier return to normal activity following LABR for Crohn's disease.