P457. Laparoscopic approach for inflammatory bowel disease is a real alternative to open surgery: an experience in 422 consecutive patients
L. Maggiori1, A. Khayat1, X. Tréton2, F. Bretagnol1, Y. Bouhnik2, Y. Panis1, 1Hôpital Beaujon, Colorectal surgery, Clichy, France, 2Hôpital Beaujon, Gastroenterology & Nutritive Assistance, Clichy, France
Feasibility of laparoscopic approach for inflammatory bowel disease (IBD) surgical management, as an alternative to open approach, has been questioned.
From June 1998 to June 2012, all patients undergoing colorectal resection for IBD were prospectively enrolled. This study aimed to report a 14-year experience of laparoscopic approach for IBD, including complicated and recurrent cases. Adjusted probability of conversion to laparotomy and postoperative morbidity were computed using a multivariate logistic regression model.
790 consecutive colorectal resections for IBD were performed on 633 patients, including 377 ileocolonic resections (48%), 149 abdominal colectomies (19%), 167 ileal pouch-anal anastomoses (21%), 60 segmental colectomies (8%), and 37 abdominoperineal resections (4%), performed for Crohn's disease (n = 504, 64%), ulcerative colitis (n = 262, 33%), or indeterminate colitis (n = 24, 3%). Laparoscopic approach was performed in 73% of the procedures, including 145 (25%) in complex cases, considered as such because of iterative surgery for IBD recurrence (n = 66, 12%) and/or because of intraoperative finding of intra-abdominal-abscess or fistula (n = 93, 16%).
Among laparoscopic procedures, 12% required a conversion to open approach. Postoperative morbidity was 33%, including 12% of severe morbidity, graded 3–4 according to Clavien-Dindo.
Splitting the study in 5 periods (98–2001, 2002–2004, 2005–2007, 2008–2010, 2011–2012), the rate of laparoscopic procedures significantly increased from 42% to 80% (p < 0.001). Among laparoscopic procedures, the rate of complex cases significantly increased (16%, 17%, 24%, 28, and 33, respectively, p = 0.023) whereas both mean adjusted probability of conversion (14%, 11%, 9%, 8%, and 6%, respectively, p < 0.001) and adjusted probability of severe postoperative morbidity (15%, 16%, 14%, 9%, and 7%, respectively, p < 0.001) significantly decreased with time.
This study demonstrated that laparoscopic approach is a safe alternative to open surgery for IBD management. With growing experience, the rate of laparoscopy for complex procedures increased, while rates of conversion and severe postoperative morbidity decreased significantly.