Search

The most common indications for laparoscopic surgery in Crohn's disease include ileocolic resection and right hemicolectomy. The aim of this study was to compare the results of right hemicolectomy in an early phase versus a later phase. Between August 1992 and October 1998 all patients who underwent laparoscopic surgery for ileocolic resection and right hemicolectomy were divided into chronological groups: Group I = August 1992 to January 1996 and Group II = February 1996 to October 1998. Statistical analysis was performed using the Mann-Whitney test, Student t test, or Fisher's exact test. We identified 41 patients; 16 patients [eight females and eight males with an average age of 37.1 (range 20–59) years] were in Group I and 25 [16 females and nine males with an average age of 41.9 (range 15–74) years] were in Group II [ P = not significant (NS)]. Overall there were five (12%) intraoperative complications reported: two (12%) in Group I and three (12%) in Group II ( P = NS). Mean operative time was 149 (range 90–260) minutes in Group I versus 158 (range 100–285) minutes in Group II ( P = NS). Mean length of hospital stay was 7.4 (range 4–18) days in Group I and 6.6 (range 3–20) days in Group II ( P = NS). Four patients (25%) in Group I and seven (28%) in Group II had their procedures converted to laparotomy ( P = NS). In Group I four (25%) patients had surgery-related postoperative complications, one of which was wound related. One patient has an anastomotic leak whereas two had prolonged postoperative ileus. In Group II six (24%) patients had surgery-related complications, two of which were wound related, three were cases of prolonged postoperative ileus, and one was an anastomotic leak ( P = NS between Groups I and II). Perhaps as a result of the relative technical ease of right-sided resections or the nature of the disease the expected decrease in morbidity and conversion rate over time could not be shown.

The aim of this study was to compare the morbidity of subtotal colectomy with ileorectal anastomosis performed for colonic inertia, Crohn's disease, familial adenomatous polyposis, and colorectal neoplasia. A retrospective review of all patients who underwent elective colectomy with ileorectal anastomosis between June 1988 and November 1996 was performed. The patients were divided into three groups: Group I, colonic inertia; Group II, Crohn's disease; and Group III, Familial Adenomatous Polyposis or other neoplasia. Outcome factors studied included the frequency of bowel movements, the incidence of small bowel obstruction, and the incidence of anastomotic leakage. Other factors assessed included operative time, intraoperative blood loss, length of hospitalization, level of ileorectal anastomosis, time of first bowel movement, and whether the operation was undertaken in one or two stages. Statistical analysis was undertaken by using the chi-square test and the Mann-Whitney U exact test. All 48 patients in Group I were operated on in one stage. In Group II (30 patients) 15 patients were operated on in one stage, eight patients had a preliminary Hartmann's operation and then ileorectal anastomosis, and seven patients underwent subtotal colectomy with both an ileorectal anastomosis and a proximal loop ileostomy. In Group III (22 patients) 20 patients underwent a one-stage operation whereas two patients underwent a subtotal colectomy with ileorectal anastomosis and proximal loop ileostomy. The median ages were 47.0 years in Group I, 43.8 in Group II, and 53.3 in Group III. Small bowel obstruction occurred in five patients (10%) in Group I, four patients (13.3%) in Group II, and four patients (18%) in Group III. The anastomotic leak rate was 4.2% (two patients) in Group 1,1% (three patients) in Group II, and 0% in Group III ( P < 0.05). At the follow up interview after surgery, the mean number of bowel movements per day 6 months after surgery was 5.4 in Group I, 7.2 in Group II, and 5.6 in Group III, ( P < 0.05, Group II vs Group I or Group III). Operative time in Group III was significantly longer than in the other two groups ( P = 0.004). No statistically significant differences were found among the three groups relative to blood loss, hospitalization, or timing of first bowel movement. This study failed to identify any differences in either immediate perioperative outcome or morbidity or intermediate-term function in patients undergoing ileorectal anastomosis regardless of diagnosis. The overall rate of small bowel obstruction was 13 per cent with no significant differences among the three groups. Lastly although the anastomotic leak rate was not significantly higher in patients with Crohn's disease it was higher in the group with ileostomy and ileorectal anastomosis, which highlights a potential advantage of performance of this procedure in two stages in selected patients of this patient population.

Since the introduction of laparoscopic-assisted ileocolic resection for Crohn disease more than 15 years ago, it has become established as a challenging but feasible and safe procedure. A crucial step in the operation is the division of the thick and chronically inflamed mesentery, which in many cases is performed extracorporeally. We report a case of a 32-year-old man with a 14-year history of Crohn ileitis who underwent elective laparoscopic-assisted ileocolic resection. His procedure and the postoperative course were uneventful. A computed tomography scan 2 weeks later revealed a 3-cm-diameter asymptomatic mesenteric pseudoaneurysm, which was successfully treated by transcatheter coil embolization. Pseudoaneurysm of mesenteric arteries has not been documented before in relation to bowel resection by conventional or minimally invasive approaches. It is likely that the thick vascular mesentery of this patient with Crohn disease was a contributing factor to this complication.