Minimal invasive surgery for Crohn's disease – indication, technique and resultsMinimal-invasive Chirurgie in der Behandlung des Morbus Crohn – Indikationen, Technik und Ergebnisse

BACKGROUND: Up to 80% of all patients with Crohn's disease undergo one or more operations during the course of their illness, despite the fact that conservative treatment plays the major role in Crohn's disease. Efficiency and safety of Crohn-surgery are well proven, but the characteristics of this incurable disease cause reoperations in up to half of all patients. So the objective in today's Crohn-surgery has to be: reduction of operative trauma while retaining a well established treatment regime. Minimal invasive surgery (MIS) appears useful for meeting these requirements. METHODS: From 8/94 to 12/03 60 patients with Crohn's disease underwent minimal-invasive operative treatment. Average age in these 38 females and 22 males was 33.1 years (16–63 ys.). Indications for laparoscopically assisted ileoceocal-resection (ICR) (n = 33), right-hemicolectomy (n = 3), left-hemicolectomy (n = 3), resection of sigmoid (n = 4), colectomy (n = 1), colostomy (n = 2) or ileostomy (n = 14) were non-responding to medical therapy or symptomatic stenosis. Exclusion criteria for laparoscopic treatment were large intraabdominal abscesses or fistulae, acute obstruction or perforation and toxic colitis. RESULTS: In 57 patients the operation could be finished laparoscopically. In 3 cases multiple adhesions required conversion to laparotomy. There were no intraoperative complications. Mean operation time was 145 min (35–360 min). In 3 cases postoperative complications (small bowel obstruction, diffuse hemorrhage, peritonitis) required surgical treatment. There was one parastomal hernia 6 months postoperatively. CONCLUSIONS: Our results show – as in the collected literature covering a total of 885 interventions – that laparoscopically assisted bowel resection or fecal diversion can be undertaken with good outcome in well-selected patients with Crohn's disease. Because of individual variation in Crohn surgery, small patient numbers and the lack of controlled randomized studies, no definite evaluation of this therapeutical option can be made at this point in time. Our positive assessment of MIS in Crohn's disease is based on well-known advantages such as increased patient-comfort.