P345. Endoscopic and clinical outcome after ileo-colic resection for Crohn's disease through laparoscopic or conventional approach
J. Bellinger1, N. Munoz-Bongrand1, C. Baudry2, M. Chirica1, B. Pariente2, M. Allez2, P. Cattan1, E. Sarfati1
1Hôpital Saint Louis, APHP, Digestive Surgery, Paris, France; 2Hôpital Saint Louis, APHP, Gastro-Enterology, Paris, France
Background: For ileo-colic resection (ICR) in Crohn's disease (CD), laparoscopy is a safe and efficient approach on the short-term. Studies assessing the impact of surgical approach on mid-term endoscopic and clinical outcome are scarce. The aim of this study was to evaluate endoscopic and clinical outcome in the year following ICR through laparoscopic approach (LICR) or conventional approach (CICR).
Methods: All cases of intestinal resection for CD on the period 2004–2010 in our center were reviewed. Inclusion criteria were: diagnosis of CD, ileo-colic resection, no previous intestinal resection. The following preoperative, operative and postoperative data were collected: duration of disease and medical treatment before surgery; surgical procedure (LICR vs. CICR); morbidity graded according to Dindo's classification; clinical follow-up at one year and at end of follow-up; endoscopic findings at one year, according to Rutgeert's classification.
Results: 64 patients (29 males, mean age 32±13 years) underwent their first ICR for CD. Mean follow-up was 31±23 months. LICR was performed in 29 patients and CICR in 35. Both LICR and CICR groups were comparable in terms of duration of CD before surgery (79±71 vs 95±101 months, p = 0.48), immunosuppressive or anti‑TNF therapy (65.5 vs 57.1%, p = 0.67), and indications for surgery (stricture: 65.5 vs 68.6%, p = 0.99; abscess: 24.1 vs 31.4%, p = 0.71; fistula: 27.6 vs 42.9%, p = 0.31). Conversion rate for LICR was 31%. Mortality was nil, and morbidity was similar (20.7 vs 20%, p = 0.81). Mean hospital stay was significantly shorter after LICR (7.65±3.64 days vs 11.31±7.46, p = 0.02).
One year after surgery, 6 patients (20.7%) in LICR group and 10 (28.6%) in CICR group presented clinical recurrence (p = 0.66). Complete ileo-colonoscopy within the first year was available after 18 LICR (64%) and 19 CICR (54%). There was no difference in rates of endoscopic recurrence between those 2 groups (83.3% vs 89.4%, p = 0.85), and no difference in severity of this recurrence (severe i3 and i4 Rutgeert's grade in 5 patients in both groups, p = 0.79).
Conclusions: Clinical outcome and rates of endoscopic relapse were similar in patients who underwent their first ICR for CD through laparoscopic or conventional approach. Considering short and mid-term results, laparoscopy should therefore be considered as the approach of choice in this procedure.