Abstract
Background
Laparoscopy is considered the best surgical approach for Crohn's Disease (CD), and
strictureplasty a reliable alternative to intestinal resection. Nevertheless, their
association has never been evaluated.
Aim
To investigate feasibility and safety of conventional (SP) and non-conventional (NCSP)
strictureplasties, using laparoscopy, for complicated CD.
Methods
Starting January 2008, a prospective cohort study was performed, in consecutive, unselected
patients, undergoing primary surgery for CD (Group-A). The residential database (CD-CARD)
was used for the retrospective extraction of control patients (Group-B). Univariate
and multi-variate analysis of pre-operative characteristics, intra-operative findings,
morbidity, and intra-abdominal septic complications (IASCs) was performed.
Results
Between January 2008 and December 2019, 331 patients received 162 SPs, 138 NCSPs,
and 373 resections (Group-A). From the CD-CARD, 227 control patients received 159
SPs, 117 NCSPs, and 271 resections (Group-B) (ns). Preoperatively, Group-A presented
batter nutritional status and received more biological therapies, Group-B more steroids.
Group-A presented less abdominal abscesses, planned ostomies, minor complications,
shorter operating time and hospitalization than Group-B, but similar major complications,
IASCs and anastomotic leaks. IASCs were related to older age, elevated inflammatory
indices, and preoperative treatment with high-risk drugs.
Conclusions
SP and NCSP are feasible by laparoscopy, with low morbidity rate, confirming the advantages
of both minimally invasive and conservative surgery.
Keywords
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Article info
Publication history
Published online: February 21, 2021
Accepted:
January 28,
2021
Received:
November 17,
2020
Footnotes
The paper has been accepted for Oral Presentation in Plenary Section at the 10° National Congress of the Italian Group for the study if IBD. Riccione, Italy, 28–30 November 2019.
Strictureplasties are safe and feasible by laparoscopic approach in patients affected by Crohn's disease, with the benefits of both minimally invasive and conservative surgery.
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
