Document Detail


Laparoscopy or conventional open surgery for patients with ileocolonic Crohn's disease? A prospective study.
MedLine Citation:
PMID:  17950349     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Crohn's patients have been considered challenging laparoscopic candidates. The aim of this study was to analyze the short-term and long-term outcomes of laparoscopic and open surgery in consecutive patients with ileocolonic Crohn's disease. METHODS: Patients were enrolled prospectively but not randomized between August 2002 and October 2006. Patients and disease-specific characteristics, intraoperative variables, and short-term and long-term postoperative outcomes were analyzed. RESULTS: Overall, 146 consecutive patients were included in the study: 59 in the laparoscopic operation group and 87 in the open operation group. Laparoscopic patients were younger (P = .001), with a lower body mass index (BMI) (P = .008). Operative time was similar between the 2 groups. Blood loss was less in the laparoscopic group (P = .012), and postoperative blood transfusions were administered only to patients in the open group. Narcotic requirement, which was expressed as days on the IV narcotics and as morphine equivalent, was less in the laparoscopic group (P = .01). Duration of stay was less in the laparoscopic group, 5.5 versus 7.0 days, (P = .001). Using step-wise multiple regression analysis, the use of laparoscopic operation was associated with a lesser hospital stay (P < .05). Complication rates were similar, which included 1 anastomotic leak that required reoperation in each group. At a median follow-up of 19 months, there have been no disease recurrences. CONCLUSIONS: In selected patients, laparoscopy leads to a faster recovery without increasing morbidity and without compromising remission. It should be considered a safe and effective alternative to open operation.
Authors:
Alessandro Fichera; Stephanie L Peng; Nicholas M Elisseou; Michele A Rubin; Roger D Hurst
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Surgery     Volume:  142     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-22     Completed Date:  2007-12-06     Revised Date:  2008-02-11    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  566-71; discussion 571.e1     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Chicago, Chicago, Illinois 60637, USA. afichera@surgery.bsd.uchicago.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Colonic Diseases / epidemiology,  surgery
Crohn Disease / epidemiology,  surgery*
Digestive System Surgical Procedures*
Female
Humans
Ileal Diseases / epidemiology,  surgery
Laparoscopy*
Male
Middle Aged
Morbidity
Postoperative Complications / epidemiology
Predictive Value of Tests
Prospective Studies
Recurrence
Risk Factors
Treatment Outcome
Comments/Corrections
Erratum In:
Surgery. 2008 Feb;143(2):301

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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