Influence of experience on laparoscopic ileocolic resection for Crohn's disease

PURPOSE: The technical difficulties that are frequently encountered in surgery for Crohn's disease have led some authors to suggest Crohn's cases should not be attempted early in one's laparoscopic colorectal surgery experience. This article reviews one surgeon's experience with laparoscopic terminal ileal resections for Crohn's disease to assess the safety of beginning laparoscopic colorectal resections with these procedures. METHODS: A retrospective review of all laparoscopic ileocolic resections performed by a single surgeon was performed. RESULTS: Sixty-nine (82 percent) of 84 procedures were completed laparoscopically. Reasons for conversion were dense adhesions (n = 5) and complex masses (n = 10). The mean operating time for the entire group was 145 +/- 39 (range, 87-289) minutes. Postoperative length of stay was 5.6 +/- 2.4 (range, 2-21) days. The mean incision length in the laparoscopic group was 4.5 +/- 1.15 cm. If the series is examined in three equal intervals, the number of patients with multiple difficulties (abscess, fistula, and previous resection or mass) increased in the final part of the study, without affecting complication or conversion rates. Despite the increased case complexity, average length of stay was significantly reduced between the second and third time periods (P = 0.008). CONCLUSIONS: Despite its technical demands, laparoscopic ileocolic resection was a safe procedure with potential advantages to patients. Laparoscopic resection is possible in the vast majority of patients with ileocolic Crohn's disease, regardless of the nature of the pathology. Previous resections, abscesses, fistulas, and phlegmons do not preclude success, although these cases should likely not be the first attempted.