Laparoscopy in Crohn Disease: Learning Curve and Current Practice.
Ann Surg
; 271(2): 317-324, 2020 02.
Article
em En
| MEDLINE
| ID: mdl-30080737
ABSTRACT
OBJECTIVE:
To identify preoperative characteristics to help in selecting laparoscopy or laparotomy in Crohn disease (CD). SUMMARYBACKGROUND:
Laparoscopy in CD is associated with high rates of conversion.METHODS:
All patients undergoing abdominal surgery for CD in 2004 to 2016 by the senior author. Patients operated by laparoscopy, laparotomy, and converted to open were compared.RESULTS:
Four hundred fifty-eight procedures were performed in 427 patients [FM 11; median age = 41 (12-95) yrs], through laparotomy (n = 157, 34%) or laparoscopy (n = 301, 66%). Laparotomy rates decreased over time. Concomitant surgical procedures requiring laparotomy continued to dictate an open approach throughout the study. Sixty-five cases (21.6%) required conversion to laparotomy which occurred within 15' from start of case in 77%. Most common reasons for conversion included dense adhesions (34%), pelvic sepsis with fistulizing disease (26%), large inflammatory mass (18%), and thickened mesentery (9%). After multivariate analysis, predictive factors for conversion included recurrent disease after previous small bowel resection, thickened mesentery, large inflammatory mass, and extensive disease.CONCLUSION:
Despite the increasing experience with laparoscopy in CD, one-fifth of selected cases still need conversion. Recurrent disease with dense adhesions, pelvic sepsis with fistulizing disease, large inflammatory mass, and thickened mesentery are all conditions predisposing to a conversion. When the severity of these conditions is known preoperatively or a simultaneous procedure requires a laparotomy, an open approach should be considered; if laparoscopy is selected, conversion to laparotomy can be decided early in the performance of the case.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doença de Crohn
/
Laparoscopia
/
Curva de Aprendizado
Tipo de estudo:
Prognostic_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Aged80
/
Child
/
Female
/
Humans
/
Male
/
Middle aged
Idioma:
En
Revista:
Ann Surg
Ano de publicação:
2020
Tipo de documento:
Article