Heather Carmichael1, Daniel Peyser2, Vanessa Baratta3, Deepika Bhasin2, Adrienne Dean4, Sergey Khaitov5, Alexander J Greenstein5, Patricia Sylla5. 1. Department of General Surgery, University of Colorado, School of Medicine. 2. Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital. 3. Department of General Surgery, Yale University School of Medicine. 4. Icahn School of Medicine at Mount Sinai Hospital. 5. Division of Colon and Rectal Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital.
Abstract
AIM: Laparoscopic surgery is the preferred approach for primary uncomplicated ileocolic resection, however its role for repeat resections is unclear. This study assessed the outcomes of primary and repeated ileocolic resections for Crohn's disease to examine rates of laparoscopy and patient morbidity. METHODS: A retrospective review of a prospectively maintained database was conducted at a tertiary centre between 2013-2019. All patients undergoing ileocolic resections for Crohn's disease were included. The cohort was divided into three groups based on number of resections - primary (1R), secondary (2R) and tertiary or more (>2R) groups. The primary outcome was 30-day postoperative morbidity. RESULTS: Over a 6-year period, 474 patients underwent ileocolic resection for Crohn's disease, including 369 primary (1R, 77.8%) and 105 repeat (≥2R, 22.2%) resections. A laparoscopic approach was less common in the ≥2R versus 1R groups (79.0% vs. 93.8%, p<0.001), but rates of conversion to an open procedure were comparable. Morbidity was higher amongst repeat resections although this was not significant (20.0% vs 14.1%, p=0.18). Amongst cases approached laparoscopically (n=429), rates of conversion and postoperative morbidity did not differ by stage of resection, although operative time was longer for repeat operations. Even in the group undergoing laparoscopy for tertiary or greater resections (>2R, n=29), the rates of conversion (10%) and morbidity (14%) were relatively low. CONCLUSION: In this contemporary series of primary and reoperative ICR for ileal CD, a laparoscopic approach is feasible and safe for the majority of repeat ileocolic resections when performed at a high volume centre. This article is protected by copyright. All rights reserved.
AIM: Laparoscopic surgery is the preferred approach for primary uncomplicated ileocolic resection, however its role for repeat resections is unclear. This study assessed the outcomes of primary and repeated ileocolic resections for Crohn's disease to examine rates of laparoscopy and patient morbidity. METHODS: A retrospective review of a prospectively maintained database was conducted at a tertiary centre between 2013-2019. All patients undergoing ileocolic resections for Crohn's disease were included. The cohort was divided into three groups based on number of resections - primary (1R), secondary (2R) and tertiary or more (>2R) groups. The primary outcome was 30-day postoperative morbidity. RESULTS: Over a 6-year period, 474 patients underwent ileocolic resection for Crohn's disease, including 369 primary (1R, 77.8%) and 105 repeat (≥2R, 22.2%) resections. A laparoscopic approach was less common in the ≥2R versus 1R groups (79.0% vs. 93.8%, p<0.001), but rates of conversion to an open procedure were comparable. Morbidity was higher amongst repeat resections although this was not significant (20.0% vs 14.1%, p=0.18). Amongst cases approached laparoscopically (n=429), rates of conversion and postoperative morbidity did not differ by stage of resection, although operative time was longer for repeat operations. Even in the group undergoing laparoscopy for tertiary or greater resections (>2R, n=29), the rates of conversion (10%) and morbidity (14%) were relatively low. CONCLUSION: In this contemporary series of primary and reoperative ICR for ileal CD, a laparoscopic approach is feasible and safe for the majority of repeat ileocolic resections when performed at a high volume centre. This article is protected by copyright. All rights reserved.
Authors: N Horesh; M R Freund; Z Garoufalia; R Gefen; D Zhang; T Smith; S H Emile; S D Wexner Journal: Tech Coloproctol Date: 2022-09-29 Impact factor: 3.699