0058 Endo + Colon
LAPAROSCOPIC ASSISTED RESECTION FOR COMPLICATED
CROHN’S DISEASE
Yaron Armon, Ram M Spira, Vered Avidan, Abi Vainstein, Oded Zmora,
Dan Odeneimer, Petachia Reissman
Department of Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
Background
Although the use of laparoscopy in Crohn’s disease (CD) has become more
common, the management of complicated CD is controversial due to the
expected technical difficulties. We here represent our recent experience.
Patients and Methods
A retrospective analysis of all laparoscopic consecutive procedures performed
for complicated CD (CCD) defined as large inflammatory mass or enteric
fistulae and non-complicated CD (NCD) between 2002-2004.
All clinical data and outcome was recorded and analyzed.
Results – see table
42 patients had 43 laparoscopic procedures during a two-year period.
Total (operations)
Total (patients)
Male / Female
Age
Length of Disease (years)
Steroids
Immunosupression
Infliximab
Inflammatory Mass
Fistula
Conversion
Length of Surgery (minutes)
Complication - operative
Complication – Post operative.
Length of Stay (days)
Non Complicated CD Complicated CD
18
25
17
25
8/9
17 / 9
32.5 (20-67)
28.5 (15-52)
10 (0-17)
7.4 (0-33)
10 / 17 (58%)
19 / 25 (76%)
7 / 17 (41%)
12 / 25 (48%)
2 / 17 (12%)
4 / 25 (16%)
0
21
0
16
0
3 / 25 (12%)
201 (40-425)
218 (45 -350)
2 / 18 (11%)
1 / 25 (4%)
3 / 18 (16%)
3 / 25 (12%)
9.7 (4-22)
9.6 (5-23)
Total
43
42
25 / 17
30.2 (15-67)
8.4 (0-33)
ׂׂ29 / 42
19 / 42
6 / 42
21
16
3 / 43 (7%)
211 (40-425)
3 / 43 (7%)
6 / 43 (14%)
9.7 (4-23)
Twenty-two fistulae were found in 16 patients (6 ileo-ileal, 2 ileo-cecal, 1 ileotransverse, 7 ileo-sigmoid, 4 ileo-vesicle, 1 ileo-vaginal and 1 recto-vaginal)
Complications included: 1 reoperation for suspected leak, which was not
identified and treated observantly (NCD group), 2 intra-abdominal abscess
(CCD group) and 3 post operative bleeding (2-NCD, 1-CCD). There was no
mortality.
Conclusions
Laparoscopic treatment of complicated Crohn’s Disease is feasible and safe in
high volume hospitals. Although associated with higher conversion rate, the
length of surgery, morbidity and length of stay are comparable to noncomplicated CD.