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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
|
Complicated CD
|
Non Complicated CD
|
|
|
43
|
25
|
18
|
Total
(operations)
|
|
42
|
25
|
17
|
Total (patients)
|
|
25 / 17
|
17 / 9
|
8 / 9
|
Male / Female
|
|
30.2 (15-67)
|
28.5 (15-52)
|
32.5 (20-67)
|
Age
|
|
8.4 (0-33)
|
7.4 (0-33)
|
10 (0-17)
|
Length of Disease (years)
|
|
29 / 42ÒÒ
|
19 / 25 (76%)
|
10 / 17 (58%)
|
Steroids
|
|
19 / 42
|
12 / 25 (48%)
|
7 / 17 (41%)
|
Immunosupression
|
|
6 / 42
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4 / 25 (16%)
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2 / 17 (12%)
|
Infliximab
|
|
21
|
21
|
0
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Inflammatory
Mass
|
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16
|
16
|
0
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Fistula
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3 / 43 (7%)
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3 / 25 (12%)
|
0
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Conversion
|
|
211 (40-425)
|
218 (45 -350)
|
201 (40-425)
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Length of Surgery (minutes)
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|
3 / 43 (7%)
|
1 / 25 (4%)
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2 / 18 (11%)
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Complication - operative
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6 / 43 (14%)
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3 / 25 (12%)
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3 / 18 (16%)
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Complication – Post operative.
|
|
9.7 (4-23)
|
9.6 (5-23)
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9.7 (4-22)
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Length of Stay (days)
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Twenty-two fistulae were found
in 16 patients (6 ileo-ileal, 2 ileo-cecal, 1 ileo-transverse, 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
non-complicated CD.
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