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LAPAROSCOPIC APPROACH IN RECURRENT ILEOCECAL CHRON’S DISEASE. IMPACT ON EARLY OUTCOME.
Andrea Vignali
*2, Alice Frontali
1, Francesco Palmieri
2, Alessandra Pecoraro
2, Luca Manfrino
2, Silvio Danese
2, Pierpaolo Sileri
21IRCCS Ospedale San Raffaele, Milan, Lombardy, Italy; 2IRCCS Ospedale San Raffaele, Milan, Lombardy, Italy
Aim: To evaluate the short-term benefit of laparoscopic ileocolic resection for recurrent Crohn disease at the anastomotic site.
Methods: One hundred and twenty-eight consecutive patients who underwent elective laparoscopic surgery for ileocolic Crohn's disease between January 2018 and November 2024 were included. Patients were grouped based on whether the surgery was redo or primary. Short term outcomes, conversion rate and 30-day morbidity were the primary outcomes.
Results: Thirty-one patients underwent redo surgery and 97 underwent primary ileocolic resection. In all patients a recurrence at the ileo-colic anastomosis was histologically confirmed. Patients in the recurrent group were older (p= 0-03), had a longer duration of disease (p=0.01) while no difference was observed between the two groups with respect to the use of immune-supressing medications (p= 0.27) and ASA score (p=0.45). In the recurrent group, previous operation/s were done using a laparotomic approach in 41.9% and laparoscopic in 58.1%. Median (range) number of previous operations was 1 (1-3). In the recurrent group, conversion rates was higher (19.3 vs 2.1% ; p= 0.01), median operative time was longer ( 198 vs 131 minutes; p= 0.01) and an increased use of temporary stoma was observed (9.6 percent vs. 0 percent, p =0.01). No difference was observed with respect to major complications, (p=0.66) or anastomotic leak rate (9.6 % in vs 5.1 % : p= 0.37) between the two groups. Patients in the recurrent group experienced a longer median length of stay when compared to primary group ( 8 vs 5 days ; p=0.03) and a trend toward a higher incidence of paralytic ileum ( 16.1% vs 6.2% ; p=0.08), while no differences were observed with respect to readmission or 30-day or reoperation rate.
Conclusion: Laparoscopic surgery for recurrent Crohn’s disease is a challenging operation, with longer operative times and an increased risk of conversion rate, but do not jeopardize postoperative complications and 30 days re-admissions.
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