LONG TERM RESULTS FROM A PROPENSITY MATCHED COHORT OF CROHN'S PATIENTS UNDERGOING LAPAROSCOPIC VERSUS OPEN COLECTOMY
Tara M. Connelly*, Cillian Clancy, Ju Yong Cheong, Xue Jia, Michael Valente, Scott Steele, Hermann Kessler
Colorectal Surgery, Cleveland Clinic, Cleveland, OH
BackgroUND: The fistulas and abscecces inherent to complicated (Montreal B3/penetrating) Crohn's disease (CD) can make laparoscopic colectomy challenging. Several previous analyses comparing the outcomes of laparoscopic vs open CD surgery are confounded by comparing unmatched groups of patients in terms of CD phenotype, body mass index (BMI), age, medication use and procedure performed. Long term outcomes are understudied.
AIM: To compare long-term outcomes of 1) subsequent intraabdominal procedure, 2) symptomatic hernia requiring operative intervention and 3) stoma reversal rates between matched patients who underwent laparoscopic and open procedures for complicated CD.
METHODS A logistic regression model was used to assign a propensity score to each patient using laparoscopic approach as the outcome and age, BMI, gender, Crohn's medication use, indication (fistula vs. abscess), ASA classification (1-2 vs 3-4) and previous abdominal surgery as the independent variables for 1:1 matching. McNemar's and Wilcoxon signed-rank tests were used for categorical and continuous variables respectively. Conditional logistic regression was used to obtain the odds ratio estimate of categorical outcomes for the matched data. A multivariable conditional logistical regression model was performed for sequential operation by adjusting for postoperative medications.
RESULTS: 386 patients were included in the analysis (193 open, 193 laparoscopic, 51.3% male, mean age 33.9+/-12.6 years). 42.5% and 4.7% underwent a subsequent intraabdominal procedure or hernia repair respectively. Mean follow up was 9.82 years. After adjusting for the use and type of postoperative medications, no association was found between operative approach and subsequent intra-abdominal operation or symptomatic incisional hernia requiring operative intervention (Table 1). There was no significant difference in the odds of undergoing a further abdominal operation between the cohorts (OR 0.91, 95%CI 0.51-1.61). Overall, the stoma reversal rate was relatively high. Patients in the laparoscopic cohort were more likely to have their stomas reversed [83.4% vs 72% in the open cohort, OR 1.9 (1.2,3.1, p=0.01), Table 2].
CONCLUSION: In the setting of complicated Crohn's disease, laparoscopic surgery has comparable symptomatic hernia and intraabdominal reoperation rates compared to open surgery. Patients undergoing laparoscopic surgery are more likely to have their stomas reversed
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