A team from the Cleveland Clinic Foundation, Cleveland, Ohio, USA compared laparoscopic vs. conventional techniques in Crohn's disease surgery.
In the prospective trial, 60 patients, median age 34.4 years, underwent elective ileocolic resection for refractory Crohn's disease.
Of the 31 patients assigned to laparoscopic and 29 to the conventional group, all had isolated Crohn's disease of the terminal ileum plus or minus the cecum. The median length of incision was 5 cm in the laparoscopic group and 12 cm in the conventional group.
Postoperatively, all patients underwent measurement of pulmonary function tests every 12 hours, and were treated identically on a highly controlled protocol with regard to analgesic administration, feeding, and postoperative care.
Recovery of 80 per cent of forced expiratory volume and forced vital capacity was a median of 2.5 days for laparoscopic surgery and 3.5 days for conventional.
There was no difference in the amount of morphine equivalents used between groups postoperatively.
|Major complications: |
1 patient in each group
4 laparoscopic patients,
|Diseases of the Colon and Rectum|
The team found that flatus and first bowel movement returned after a median of 3 and 4 days, respectively, after laparoscopic surgery, vs. 3.3 and 4 days, respectively, after conventional surgery.
Median length of stay was 5 days for laparoscopic, and 6 days for conventional surgery. Major complications occurred in one patient in each group, whilst minor complications occurred in 4 laparoscopic and 8 conventional patients. Two laparoscopic patients were converted to conventional as a result of adhesions or inflammation. No deaths occurred.
All patients recovered well and there were no clinical recurrences in the follow-up period (median, 20 months).
Dr Jeffrey W. Milsom concluded on behalf of the group, "In this trial, laparoscopic techniques offered a faster recovery of pulmonary function, fewer complications, and shorter length of stay compared with conventional surgery."