Endoscopic and clinical recurrences after laparoscopic or open ileocolic resection in Crohn's disease.

BACKGROUND After ileocolic resection in Crohn's disease, studies concerning the influence of the laparoscopic or open approach on clinical and endoscopic recurrences are scarce. PATIENTS AND METHODS In a prospective database, we identified all patients operated on between 2004 and 2012 for primary ileocolic resection in Crohn's disease, with at least 6 months of follow-up. The rates of endoscopic recurrence during the first postoperative year and the clinical recurrence at any time during follow-up were measured and compared after the laparoscopic or open approach. RESULTS Sixty-two patients (mean±standard deviation age, 33.5±12.7 years; 35 females) were operated on through laparoscopy (n=28) or laparotomy (n=34). Medical treatment, evolution and phenotype of disease, and postoperative course were comparable in both groups. Mean±standard deviation follow-up was 3.5±1.9 years. Ileocolonoscopy was available in 46 (74.2%) patients. Normal endoscopy or minor recurrence (i0 or i1 grade) was significantly more frequent after laparoscopy (14/24 [58.3%]) versus laparotomy (5/22 [22.7%]) (P=.019). Clinical recurrence was comparable at 1 year (P=.116) and at the end of follow-up (P=.799) after laparoscopy (28.6% and 50%, respectively) or laparotomy (11.8% and 55.9%, respectively). CONCLUSIONS After resection, normal or minor endoscopic lesions (i0 or i1 grade) were more frequent after laparoscopy than after laparotomy. However, clinical recurrence was similar after both techniques.

[1]  A. Amiot,et al.  European evidence based consensus for endoscopy in inflammatory bowel disease. , 2013, Journal of Crohn's & colitis.

[2]  W. Sandborn,et al.  Crohn's disease , 2012, The Lancet.

[3]  A. Zinsmeister,et al.  Surgery in a Population-Based Cohort of Crohn's Disease From Olmsted County, Minnesota (1970–2004) , 2012, The American Journal of Gastroenterology.

[4]  G. Wang,et al.  Immunologic Response After Laparoscopic Colon Cancer Operation Within an Enhanced Recovery Program , 2012, Journal of Gastrointestinal Surgery.

[5]  L. Peyrin-Biroulet,et al.  Review article: the natural history of postoperative Crohn's disease recurrence , 2012, Alimentary pharmacology & therapeutics.

[6]  M. Cuesta,et al.  Surgical Stress Response and Postoperative Immune Function After Laparoscopy or Open Surgery With Fast Track or Standard Perioperative Care: A Randomized Trial , 2012, Annals of surgery.

[7]  L. Peyrin-Biroulet,et al.  Surgery for adult Crohn's disease: what is the actual risk? , 2011, Gut.

[8]  K. Behrns.  Recurrence and Impact of Postoperative Prophylaxis in Laparoscopically Treated Primary Ileocolic Crohn Disease , 2011 .

[9]  Geraint T. Williams,et al.  Natural history of Crohn's disease in a population-based cohort from Cardiff (1986–2003): a study of changes in medical treatment and surgical resection rates , 2010, Gut.

[10]  M. Allez,et al.  Role of endoscopy in predicting the disease course in inflammatory bowel disease. , 2010, World journal of gastroenterology.

[11]  R. Rouzier,et al.  Randomized Trial of Laparoscopically Assisted Versus Open Colorectal Resection for Endometriosis: Morbidity, Symptoms, Quality of Life, and Fertility , 2010, Annals of surgery.

[12]  T. Carus,et al.  Short‐term outcomes from a prospective randomized trial comparing laparoscopic and open surgery for colorectal cancer , 2009, The British journal of surgery.

[13]  D. Sachar,et al.  Recurrence patterns after first resection for stricturing or penetrating Crohn's disease , 2009, Inflammatory bowel diseases.

[14]  S. Ng,et al.  Clinical and surgical recurrence of Crohn's disease after ileocolonic resection in a specialist unit , 2009, European journal of gastroenterology & hepatology.

[15]  Y. Panis,et al.  Impact of Complex Crohn's Disease on the Outcome of Laparoscopic Ileocecal Resection: A Comparative Clinical Study in 124 Patients , 2009, Diseases of the colon and rectum.

[16]  F. Carbonnel.  Maladie de Crohn , 2009 .

[17]  V. Fazio,et al.  Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: follow-up of a prospective randomized trial. , 2008, Surgery.

[18]  D. Gouma,et al.  Long-Term Surgical Recurrence, Morbidity, Quality of Life, and Body Image of Laparoscopic-Assisted vs. Open Ileocolic Resection for Crohn’s Disease: A Comparative Study , 2008, Diseases of the colon and rectum.

[19]  A. Gaspari,et al.  Laparoscopic Versus Open Ileo-Colonic Resection in Crohn’s Disease: Short- and Long-Term Results from a Prospective Longitudinal Study , 2008, Journal of Gastrointestinal Surgery.

[20]  William J. Tremaine,et al.  Update on the incidence and prevalence of Crohn's disease and ulcerative colitis in Olmsted County, Minnesota, 1940–2000 , 2007, Inflammatory bowel diseases.

[21]  A. Fichera,et al.  Surgical Treatment of Crohn’s Disease , 2007, Journal of Gastrointestinal Surgery.

[22]  M. Kaminishi,et al.  Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery , 2006, The British journal of surgery.

[23]  D. Gouma,et al.  Laparoscopic-Assisted Versus Open Ileocolic Resection for Crohn's Disease: A Randomized Trial , 2006, Annals of surgery.

[24]  J. Fleshman,et al.  Is There Any Difference in Recurrence Rates in Laparoscopic Ileocolic Resection for Crohn's Disease Compared With Conventional Surgery? A Long-Term, Follow-Up Study , 2006, Diseases of the colon and rectum.

[25]  K. Slim,et al.  French multicentre prospective observational study of laparoscopic versus open colectomy for sigmoid diverticular disease , 2005, The British journal of surgery.

[26]  A. Rosman,et al.  Metaanalysis of trials comparing laparoscopic and open surgery for Crohn’s disease , 2005, Surgical Endoscopy And Other Interventional Techniques.

[27]  J. Satsangi,et al.  Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Party of the 2005 Montreal World Congress of Gastroenterology. , 2005, Canadian journal of gastroenterology = Journal canadien de gastroenterologie.

[28]  N. Demartines,et al.  Classification of Surgical Complications: A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey , 2004, Annals of Surgery.

[29]  M. Solomon,et al.  Laparoscopic versus open ileocolic resection for Crohn's disease. , 2004, Journal of laparoendoscopic & advanced surgical techniques. Part A.

[30]  J. Belaiche,et al.  Placebo‐controlled clinical trial of mesalazine in the prevention of early endoscopic recurrences after resection for Crohn's disease , 1996, European journal of gastroenterology & hepatology.

[31]  P. Rutgeerts,et al.  Predictability of the postoperative course of Crohn's disease. , 1990, Gastroenterology.

[32]  P. Rutgeerts,et al.  Natural history of recurrent Crohn's disease at the ileocolonic anastomosis after curative surgery. , 1984, Gut.