Ileocolectomy

Abstract: Hypothesis Laparoscopic ileocolectomy can reduce the length of hospital stay and hospital charges compared with conventional surgery in the treatment of primary Crohn disease. Design Nonrandomized, comparative, retrospective analysis of a prospective database. Setting University hospital tertiary care center for inflammatory bowel disease. Patients Forty patients, 20 in the laparoscopic group (group A) and 20 in the conventional group (group B). Intervention From July 1, 1996, to June 30, 2001, we collected data on the following demographic clinical end points: age, sex, duration of disease, preoperative medical treatment, previous abdominal surgery, procedure performed, conversions to open surgery, operating time, number of trocars used, size of incision, blood loss, time to resolution of ileus, time to starting solid food diet, duration of hospital stay, hospital charges, morbidity, and mortality. Main Outcome Measures Surgical results, length of hospital stay, hospital charges, and recurrences. Results The mean age of the patients was 34.7 years (range, 20-68 years) in group A vs 40.0 years (range, 18-75 years) in group B. The male-female ratio was 1:2 in group A vs 1:1 in group B. The morbidity was 5% in group B. There was no mortality. Operating time was longer in group A (mean, 145.0 minutes; range, 45-270 minutes) compared with group B (mean, 133.5 minutes; range, 98-177 minutes) ( P = .36). Blood loss was significantly higher in group B (mean, 265.5 mL; range, 100-400 mL) compared with group A (77.2 mL; range, 25-350 mL) ( P P P P P P Conclusions Laparoscopic-assisted ileocolectomy for primary Crohn disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn disease should be considered as the preferred operative approach for primary resections.

Abstract: Laparoscopically assisted intestinal surgery has been described in a variety of different intestinal diseases but not in inflammatory bowel disease. The study shows that laparoscopically assisted ileocolectomy is feasible in patients with Crohn's disease with low morbidity.

Abstract: Background: Crohn's disease (CD) patients are typically underweight; however, a growing cohort of overweight CD patients is emerging. The current study investigates whether body mass index (BMI) or volumetric fat parameters can be used to predict morbidity after ileocolectomy for CD. Methods: One hundred and forty-three CD patients who underwent elective ileocolectomy were identified from our Inflammatory Bowel Disease (IBD) Registry. Patient demographics and operative outcomes were recorded. Visceral (VA) and subcutaneous (SA) adiposity and abdominal circumference (AC) were analyzed on preoperative CT scans using Aquarius iNtuition software. A visceral/subcutaneous ratio (VSR) was calculated. Results: BMI correlated with SA (p = 0.0001), VA (p = 0.0001) and AC (p = 0.0001) but not VSR (p > 0.05). BMI, VA and AC did not predict surgical morbidity (p > 0.05). In multivariate regression analysis, family history of IBD (p = 0.009), high American Society of Anesthesiologists score (p = 0.02) and increased VSR (p = 0.03) were independent predictors of postoperative morbidity. Conclusions: The visceral/subcutaneous fat ratio is a more reliable predictor of postoperative outcomes in CD patients undergoing ileocolectomy than conventional adiposity markers such as BMI. Preoperative calculation of the visceral/subcutaneous fat ratio offers the opportunity to optimize high-risk surgical patients, thus improving outcomes.