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P338. The safety of laparoscopy in complex Crohn's disease

N. Dimitriou1, P. Morar1, J. Warusavitarne1, 1St Mark's Hospital, Colorectal, London, United Kingdom

Background

Our study aims to evaluate the safety and short-term outcome of laparoscopic surgery for recurrent ileocolic Crohn's disease for both perforating and stricturing phenotypes.

Methods

From June 2011 to September 2012, 12 patients underwent laparoscopic ileocolic resection for recurrent stricturing (Montreal B2) and perforating (Montreal B3) disease including complex fistulating Crohn's disease. Data were collected retrospectively and included patient demographics, previous medical and surgical history, recent operative details and postoperative outcome.

Results

From July 2011 to September 2012, 12 patients (mean age 43) underwent laparoscopic ileocolic resection.

58.3% (7/12) of patients had previous ileocaecal resections and 41.6% (5/12) of them had complex fistulating ileocolic Crohn's disease. 85.7% of patients had one previous ileocaecal resection; one of the patients had two previous resections. A previous open ileocaecal resection was noted in six of the seven patients, and one had laparoscopic procedure.

Five patients had complex fistulating disease communicating the terminal ileum to the sigmoid colon, bladder, uterus, anterior abdominal wall, psoas muscle or adjacent small bowel.

The conversion rate was 25% (3/12) and the mean operative time was 153.3 minutes. The mean hospital stay was 7 days.

Two patients (16.6%) had pelvic collections and had ultrasound guided drainage. In both cases, the operation was converted from laparoscopic to open. One patient was readmitted to hospital because of acute renal failure, due to antibiotics. There was no reoperation or mortality in our group.

Conclusion

Even though redo ileocolic resection is more difficult and more demanding than the primary ileocaecal resection, it is a safe procedure.

The complication rate in our study was 16.6%, with zero reoperation and mortality. Despite a longer hospital stay in comparison to the primary resection, the benefits for laparoscopic ileocolic re-resection are preserved.

Patients with Crohn's disease are usually young and generally healthy, making them potentially optimal candidates for laparoscopic procedures. Approximately 40% to 50% of patients undergoing surgery are likely to need another operation, laparoscopy can reduce adhesion formation and can make the following operation easier.

Patients with complex ileocolic Crohn's disease can undergo laparoscopic procedures, in the hands of an experienced IBD surgeon. The patients must be well selected and the threshold for conversion to open must be low.