Prospective, randomized trial comparing laparoscopic vs.... : Diseases of the Colon & Rectum (original) (raw)
Original Contributions: PDF Only
Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic crohn's disease
Milson, Jeffrey W. M.D.1,2; Hammerhofer, Katherine A. R.N., B.S.N.1; Böhm, Bartholomaus M.D., Ph.D.1,2; Marcello, Peter M.D.1,2; Elson, Paul Ph.D.6; Fazio, Victor W. M.B., M.S., F.R.A.C.S.1
1From the Department of Colorectal Surgery
The Cleveland Clinic Foundation
Cleveland
Ohio
6From the Department of Biostatistics
The Cleveland Clinic Foundation
Cleveland
Ohio
2From the Department of Minimally Invasive Surgery Center
The Cleveland Clinic Foundation
Cleveland
Ohio
4Division of Colon and Rectal Surgery
Mount Sinai School of Medicine
New York
New York
5Department of Surgery
Charité Hospital, The Humboldt University
Berlin
Germany
3 Mount Sinai School of Medicine
5 East 98th Street, 15th Floor
10029
New York
New York
Supported by United States Surgical Corporation, Norwalk, Connecticut, and the Minimally Invasive Surgery Center of the Cleveland Clinic Foundation.
Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.
Abstract
INTRODUCTION:
Surgeons have been reluctant to apply laparoscopic techniques to Crohn's disease surgery because of concerns with evaluating and excising inflamed tissue using laparoscopic methods Additionally in Crohn's disease surgery, laparoscopic techniques have not been demonstrated to have clear advantages over conventional ones.
METHOD:
We conducted a prospective, randomized trial in one surgical department comparing laparoscopic vs. conventional techniques in 60 patients (25 males), median age 34.4 (range 10-60.1) years, undergoing elective ileocolic resection for refractory Crohn's disease. Postoperatively, all patients underwent measurement of pulomnary function tests every 12 hours, and were treated identically on a highly controlled protocol with regard to analgesic administration, feeding, and postoperative care.
RESULTS:
Of the 31 patients assigned to laparoscopic and 29 to the conventional group, all had isolated Crohn's disease of the terminal ileum plus or minus the cecum. Median length of the incision was 5 cm in the laparoscopic group and 12 cm in the conventional group. Overall recovery of 80 percent of forced expiratory volume (one second) and forcec vital capacity was a median of 2.5 days for laparoscopic and 3.5 days for conventional (P =0.03). There was no difference in the amount of morphine equivalents used between groups postoperatively. Flatus and first bowel movement returned a median of 3 and 4 days, respectively, after conventional roscopic vs. 3.3 and 4 days, respectively, after conventional surgery (P =0.21). Median length of stay was five (range, 4-30) days for laparoscopic, and six (range, 4-18) days for conventional surgery. Major complications occurred in one patient in each group. Minor complications occurred in four laparoscopic and eight conventional patients (P <0.05). There were no deaths. Two laparoscopic patients were converted to conventional as a result of adhesions or inflammation. All patients recovered well and there were no clinical resurrences in the follow-up period (median, 20; range, 12-45 months).
CONCLUSIONS:
Within a single insititution, single surgical team, prospective, randomized trial, laparoscopic techniques offered a faster recovery of pulomary function, fewer complications, and shorter length of stay compared with conventional surgery for selected patients undergoing ileocolic resection for Crohn's disease.
© The ASCRS 2001