Laparoscopic Management of Complex Crohn's Disease

BACKGROUND: Although the technical feasibility of laparoscopic management of Crohn's disease has been described, it remains of limited perceived usefulness in the management of surgically complex Crohn's. Successful management of such disease by using minimal access techniques is described. PATIENTS AND METHODS: Seventeen patients underwent laparoscopically assisted procedures to address clinically complex disease. Goals of the laparoscopic phase included mobilization of pertinent structures, localization of disease, and precise selection of incision location. Clinical situations encountered included fistulas, multiple-or long-segment disease, abscesses, and reoperative management. RESULTS: Conversion to completely open procedures was not necessary in any case. Operative time was longer in complex Crohn's disease than in concurrently managed patients who underwent laparoscopic ileal/cecal resection for limited disease (244±18 vs 127±5 minutes, P<0.05). Management of long-segment or multi-segment disease was associated with the longest operative times (292±36 minutes). Length of hospitalization was also longer than after management of limited ileal disease (7.1±1.4 vs 4.5±0.4 days). Major complications occurred in 18%. CONCLUSIONS: Laparoscopic techniques can be applied to complex Crohn's disease with effective disease management. In patients who may require multiple procedures, maintenance of abdominal wall integrity should be of significant value.