Minimal-invasive approach for penetrating Crohn’s disease is not associated with increased complications

• DOI: 10.1007/s00464-016-4871-4
• Publication Date: 2016-06-23T07:03:11Z
• Authors: Ivan Kristo; Anton Stift; Stanislaus Argeny; Martina Mittlböck; Stefan Riss
• Keywords: Adult; Male; Anastomosis, Surgical; Severity of Illness Index; Article; 3. Good health; 03 medical and health sciences; Postoperative Complications; Treatment Outcome; 0302 clinical medicine; Crohn Disease; Intestinal Perforation; Case-Control Studies; Humans; Minimally Invasive Surgical Procedures; Surgery; Female; Laparoscopy; Colectomy

Laparoscopic surgery for penetrating Crohn's disease (CD) still remains highly conflicting due to a lack of sufficient data. Therefore, the following large study was designed to compare postoperative outcomes after minimal-invasive resections for penetrating and non-penetrating CD.Consecutive patients, who underwent laparoscopic intestinal resection for symptomatic CD at a tertiary academic referral center, were included. Patients were divided according to perioperative findings in penetrating and non-penetrating type of disease. All clinical data were obtained from an institutional database and analyzed retrospectively.Of 234 patients enrolled, 101 patients [females: n = 54 (53.5 %)] were operated on for non-penetrating CD and 133 patients [females: n = 50 (37.6 %)] for penetrating CD. Fistulas (p < 0.001), inflammatory mass (p < 0.001) and abscess formation (p < 0.001) were observed more frequently in the perforating group. Ileocolic resections were performed predominantly in both groups [perforating CD: n = 110 (82.7 %), non-perforating CD: n = 82 (81.2 %)], with more complex resections (>1 intestinal resection) found in perforating CD (p < 0.001). Conversion rates did not differ significantly. Notably, 30-day postoperative morbidity was comparable for both groups [perforating CD: n = 20 (15 %), non-perforating CD: n = 19 (18.8 %), p = 0.44]. Postoperative complication rates graded according to the Clavien-Dindo classification showed no difference too (p = 0.49).Laparoscopic surgery can be conducted safely in selected patients with penetrating CD without increasing the risk of postoperative complications. This finding needs to be implemented in future guidelines.