Laparoscopic resection for Crohn's disease: An experience with 335 cases

Background: Laparoscopic resection for Crohn's disease has had a slow adoption rate in gastrointestinal surgery. This is not unexpected considering the inflammatory nature of the disease, the need for reoperative surgery, and the presence of fistulas. The authors review their experience with 335 laparoscopic resections for Crohn's disease over the past 15 years. Methods: This study is a retrospective analysis of a prospective database from one surgeon at the Mount Sinai Hospital, New York, NY. Results: Since 1993, 335 patients with Crohn's disease in the current series have undergone laparoscopic resection. The mean age of the patients was 39 years, and 54% of the patients were women. In most cases, the indication for surgery was intestinal obstruction (73%) or abdominal pain (16%). The most common operation was primary ileocolic resection, performed for 178 cases (49%). Secondary ileocolic resections were performed for 20% and small bowel resections for 11% of the cases. Of the 117 patients with enteric fistulas, 45% had multiple fistulas. There were 80 enteroenteric, 51 ileosigmoid, 33 enteroabdominal wall, and 22 ileovesical fistulas. Multiple resections were performed for 33 patients (9%). Eight conversions occurred (2%), primarily because of large inflammatory masses involving the intestinal mesentery. The mean length of hospital stay was 5 days, and the mean operative time was 177 min (range, 62-400 min). There were no mortalities. The complications were primarily bowel obstruction, anastamotic leak, and postoperative bleeding, resulting in a postoperative complication rate of 13%. Conclusion: This review summarizes the largest series of laparoscopic resection for Crohn's disease to date. The most common operation performed was ileocolic resection. Fistulous disease is common, but it is not a contraindication to laparoscopic resection. These cases can be managed safely and with acceptable morbidity in experienced hands.