Total intracorporeal laparoscopic resection of Crohn's disease

Background/Purpose: The benefits of laparoscopic resection for Crohn's disease have been well established in the adult literature. This modality more recently has been applied to children. The authors report their experience in this age group. Methods: A prospective series of all pediatric Crohn's patients treated laparoscopically in one surgical practice was studied for demographic data, operative details, and outcome. Results: Fifteen patients with diagnosis of Crohn's disease, ages 9 to 17 years, underwent laparoscopic ileocolic resection between February of 1998 and 2002. Patients' weights ranged from 42 to 80 kg. All patients had fixed strictures involving the terminal ileum and ileocecal valve and had failed medical therapy. A 4-port approach (one 12-mm and 3 5-mm) was utilized in all cases. Resection and anastomosis was performed intracorporeally, and the specimen was retrieved through the 12-mm port site. The average operating time was 110 minutes (range, 90 to 180 minutes). Oral feedings were started after 24 hours of nasogastric suction. Hospital stay averaged 4 days (range, 3 to 8 days). One patient had a fever on postoperative day 3. Contrast study showed a small anastomotic leak with no associated collection, and the patient responded to conservative management. One other patient whose pathologic diagnosis questioned the initial Crohn's diagnosis presented with an anastomotic stricture and underwent redo resection laparoscopically with good outcome. No other complications were noted, and all patients were symptom free at follow-up. Conclusions: Laparoscopic resection of Crohn's disease in children is safe and effective.