Published online Nov 7, 2021. doi: 10.3748/wjg.v27.i41.7159
Peer-review started: March 16, 2021
First decision: May 1, 2021
Revised: May 8, 2021
Accepted: October 18, 2021
Article in press: October 18, 2021
Published online: November 7, 2021
Laparoscopic ileocolic resection (LICR) is the preferred surgical approach for primary ileocolic Crohn’s disease (CD) because it has greater recovery benefits than open ICR (OICR).
To compare short- and long-term outcomes in patients who underwent LICR and OICR.
Patients who underwent ICR for primary CD from 2006 to 2017 at a single tertiary center specializing in CD were included. Patients who underwent LICR and OICR were subjected to propensity-score matching analysis. Patients were propensity-score matched 1:1 by factors potentially associated with 30-d perioperative morbidity. These included demographic characteristics and disease- and treat
During the study period, 348 patients underwent ICR, 211 by the open approach and 137 laparoscopically. Propensity-score matching yielded 102 pairs of patients. The rate of postoperative complication was significantly lower (14% versus 32%, P = 0.003), postoperative hospital stay significantly shorter (8 d versus 13 d, P = 0.003), and postoperative pain on day 7 significantly lower (1.4 versus 2.3, P < 0.001) in propensity-score matched patients who underwent LICR than in those who underwent OICR. Multivariate analysis showed that postoperative complications were significantly associated with preoperative treatment with biologics [odds ratio (OR): 3.14, P = 0.01] and an open approach to surgery (OR: 2.86, P = 0.005). The 5- and 10-year SRFS rates in the matched pairs were 92.9% and 83.3%, respectively, with SRFS rates not differing significantly between the OICR and LICR groups. The performance of additional procedures was an independent risk factor for surgical recurrence [hazard ratio (HR): 3.28, P = 0.02].
LICR yielded better short-term outcomes and postoperative recovery than OICR, with no differences in long-term outcomes. LICR may provide greater benefits in selected patients with primary CD.
Core Tip: The laparoscopic approach to ileocolic resection can be safely performed in patients with primary Crohn’s disease (CD), resulting in fewer postoperative complications, faster postoperative recovery, and non-inferior surgical recurrence rate when compared with open surgery. Postoperative complications were significantly associated with preoperative use of biologics and open ileocolic resection. Additional procedures were found to be independent risk factors for surgical recurrence in patients with CD.