Author
Year
No. of patients
OP time (min)
LOS (day)
Morbidity (%)
Comment
LAP
Open
LAP
Open
LAP
Open
LAP
Open
Bauer et al.
1996
25
14
–
–
6.5
8.5
–
–
High conversion if mass and fistula
Wu et al.
1997
46
70
144
202
4.5
7.9
10
21
52 % complex or redo cases
Dunker et al.
1998
11
11
–
–
5.5
9.9
9
9
Improved cosmesis
Wong et al.
1999
55
150
6.0
5
46 % complex cases
Canin-Endres et al.
1999
70
183
4.2
14
41 with fistulae, 1 conversion
Alabaz et al.
2000
26
48
150
90
7.0
9.6
–
–
Favorable results
Bemelman et al.
2000
30
48
138
104
5.7
10.2
15
10
Different hospitals for each group
Young-Fadok et al.
2001
33
33
147
124
4.0
7.0
–
–
Laparoscopy less expensive
Schmidt et al.
2001
46
207
5.7
Safe and effective, high conversion rate
Milsom et al.
2001
31
29
140
85
5.0
6.0
16
28
Prospective, randomized trial
Evans et al.
2002
84
145
5.6
11
Results improve with experience
Dupree et al.
2002
21
24
75
98
3.0
5.0
14
16
Laparoscopy less expensive
Shore et al.
2003
20
20
145
133
4.3
8.2
–
–
Laparoscopy less expensive
Benoist et al.
2003
24
32
179
198
7.7
8.0
20
10
Similar operative times, 17 % converted
Bergamaschi et al.
2003
39
53
185
105
5.6
11.2
9
10
Long-term obstruction less, 11 % vs. 35 %
Huilgol et al.
2004
21
19
136
120
6.4
8.2
19
16
Rosman et al.
2005
26.8 min longer
2.62 days less
OR 0.62
Meta-analysis, SBO reduced in LAP cases
Tilney et al.
2006
338
445
29.6 min longer
Meta-analysis, conversion 6.8 %
Tan et al.
2007
26 min longer
1.82 days less
12.8
20.2
Meta-analysis, conversion 11.2 %
Lesperance et al.
2009
2,826 (6 %)
46,783
6.0
9.0
8
16
Nationwide Inpatient Sample
Soop et al.
2009
109
150
4.0
11
Conversion 6 %
Nguyen et al.
2009
335
177
5.0
13
Largest series, conversion rate 2 %
The majority of studies are retrospective case–control series and report conversion rates from 10 to 20 %, which increases to 40–50 % with complex cases (abscess, fistula, or reoperative surgery).
Without tactile sensation, one of the concerns of laparoscopic surgery in the patient with Crohn’s is missing an isolated proximal ileal lesion, but this has not been reported.
Crohn’s recurrence rates after laparoscopy are similar to conventional procedures.
Laparoscopic resection for Crohn’s disease appears to be safe.
Ulcerative Colitis
Studies of laparoscopic proctocolectomy for ulcerative are summarized in Tables 35.2 and 35.3.
Table 35.2
Early descriptive studies of laparoscopic colectomy for ulcerative colitis
Author
Year
No. of patients
Comment
Meijerink et al.
1999
10
Feasible, 7 for acute colitis
Marcello et al.
2000
13
Restorative proctocolectomy, favorable results
Seshadri et al.
2001
37
25 % morbidity
Hamel et al.
2001
21
Compared with ileocolic resection, similar morbidity, and LOS
Marcello et al.
2001
16
For acute colitis, comparative study, favorable results
Brown et al.
2001
25
Longer OP time in LAP group
Dunker et al.
2001
35
Better cosmesis
Ky et al.
2002
32
Single-stage procedure, good results
Bell and Seymour
2002
18
Total colectomy for acute colitis, seems safe
Rivadeneira et al.
2004
23
Hand-assisted procedure, reduced operative time
Kienle et al.
2003
59
Large study, laparoscopic colon mobilization only
Nakajima et al.
2004
16
Hand-assisted technique, favorable results
Table 35.3
Comparative studies of laparoscopic resection for ulcerative colitis
Author
Year
No. of patients
OP time (min)
LOS (day)
Morbidity (%)
Comment
LAP
Open
LAP
Open
LAP
Open
LAP
Open
Maartense et al.
2004
30
30
210
133
10
11
20
17
SF-36 and GIQLI scores similar
Larson et al.
2006
100
200
333
230
4
7
33
37
LAP faster than hand assisted (320 min vs. 372 min)
Zhang et al.
2007
21
25
325
220
9
11
25
28
Benavente-Chenhalls
2008
16
16
500
382
25
44
5.3
9.9
UC and primary sclerosing cholangitis
Ahmed Ali et al.
2009
253
354
91 min longer
2.7 days less
38–47
42–53
Cochrane review
Fichera et al.
2009
73
106
335
322
8.3
7.4
Incisional hernia repair 7.8 % open vs. 0 % LAP
Chung et al.
2009
37
44
223
140
4.9
8.5
9/37
21/44
1st of 3 stage procedure, 2nd stage earlier in LAP
Recent reports demonstrate that laparoscopic total colectomy and proctocolectomy with and without ileal pouch-anal anastomosis is technically feasible and shares the same advantages as seen with segmental colonic resection.
Indar et al. showed that adhesions are reduced with laparoscopic pouch procedures, in a series of 34 patients (21 females).
Diverticulitis
There are now a large number of studies evaluating laparoscopic surgery for diverticulitis (Tables 35.4 and 35.5).
Table 35.4
Descriptive series of laparoscopic resection for diverticulitis
Study
Year
N
Mortality (%)
Morbidity (%)
Conversion (%)
OR time (min) a
Resume diet (day)a
Flatus/BM (day)a
LOS (day)a
Eijsbouts et al.
1997
41
0
18
15
195
NA
NA
6.5
Stevenson et al.
1998
100
0
21
8
180
2
2
4
Tuech et al.
2000
77
0
17
14
NA
NA
NA
NA
Trebuchet et al.
2002
170
0
8.2
4.1
141
3.4
NA
8.5
Bouillot et al.
2002
179
0
15
14
223
3.3
2.5
9.3
Pugliese et al.
2004
103
0
8
3
190
NA
4
9.7
Schneidbach et al.
2004
1,545
0.4
17
6.1
169
NA
NA
NA
Pessaux et al.
2004
582
1.2
25
NA
NA
NA
NA
NA
Schwandner et al.
2005
363
0.6
22
6.6
192
2.8
4.0
11.8
Jones et al.
2008
500
0.2
11
8–1.5
120
NA
NA
4
Table 35.5
Case–control studies of laparoscopic resection for diverticulitis
Study
Year
No. of patients
Mortality (%)
Morbidity (%)
Convert (%)
OR time (min)a
Resume diet (day)
Flatus/BM (day)
LOS (day)
Total costsa
CON
LAP
CON
LAP
CON
LAP
CON
LAP
CON
LAP
CON
LAP
CON
LAP
CON
LAP
Diverticulitis
Liberman et al.
1996
14
14
0
0
14
14
0
182
192
6.1
2.9b
NA
9.2
6.3b
P 13,400
11,500Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
Get Clinical Tree app for offline access
