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.
