Minimally invasive colectomy for Crohns colitis: A single institution experience

Background: Minimally invasive surgery for Crohns ileocolitis is well established but few data exist regarding laparoscopic techniques for Crohns colitis. We aimed to describe outcomes associated with minimally invasive surgery for Crohns colitis, including predictors of conversion to laparotomy and postoperative complications. Methods: We identified all Crohns patients who underwent minimal invasive colectomy at our institution from 1997-2008. Data represent frequency (proportion) or median (interquartile range). Multivariate regression identified factors associated with conversion and 30-day complications (odds ratio [95% confidence interval]). Results: Over 11 years we identified 92 patients, median age 40 (26-51) years, body mass index (BMI) 22.9 (19.3-26.4) kg/m²; 61% were women. Median Crohns duration was 6.5 (4-15) years, 11% had prior intestinal resection; medications included immunomodulators (62%), corticosteroids (54%), infliximab (35%). Forty-three cases (47%) were total colectomy, 17 (18%) subtotal colectomy, 32 (35%) were segmental. Straight laparoscopy was used in 57%; 43% were hand-assisted. Median operative time was 248 (190-292) minutes. There were 15 (16%) conversions; only small bowel disease predicted conversion (OR 7 [1.6-35]). Conversion was not associated with increased length of stay or with postoperative complications. Overall postoperative length of stay was 5 (4-7) days. Short-term complications occurred in 34% with reoperation in 5: obstruction n = 3, anastomotic leak n = 2. Only perianal disease predicted complications (2.6 [1.0-6.6]). There was no 30-day mortality. Conclusions: Minimally invasive colectomy in patients with Crohns colitis can be safely accomplished with reasonable operative times, conversion rates, and excellent postoperative outcomes. Inflamm Bowel Dis 2010