Editorial
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Apr 16, 2017; 9(4): 149-152
Published online Apr 16, 2017. doi: 10.4253/wjge.v9.i4.149
Laparoscopic surgery for complex and recurrent Crohn’s disease
Yusuf Sevim, Cihangir Akyol, Erman Aytac, Bilgi Baca, Orhan Bulut, Feza H Remzi
Yusuf Sevim, Department of General Surgery, Kayseri Training and Research Hospital, Kayseri 38110, Turkey
Cihangir Akyol, Division of Colorectal Surgery, Department of General Surgery, Ankara University School of Medicine, Ankara 06000, Turkey
Erman Aytac, Bilgi Baca, Department of General Surgery, Medical School, Acibadem University, Istanbul 34457, Turkey
Orhan Bulut, Department of Surgical Gastroenterology, Copenhagen University Hospital, 2650 Hvidovre, Denmark
Feza H Remzi, Inflammatory Bowel Disease Center, New York University, Langone Medical Center, New York, NY 10029, United States
Author contributions: Sevim Y, Akyol C, Aytac E, Baca B, Bulut O and Remzi FH contributed to conception and design; Sevim Y, Akyol C and Aytac E contributed to acquisition of data; Sevim Y, Akyol C, Aytac E, Baca B, Bulut O and Remzi FH contributed to analysis and interpretation of data; Sevim Y, Akyol C and Aytac E contributed to drafting the article; Sevim Y, Akyol C, Aytac E, Baca B, Bulut O and Remzi FH contributed to critical revision; Sevim Y, Akyol C, Aytac E, Baca B, Bulut O and Remzi FH approved the final version of the article to be published.
Conflict-of-interest statement: The authors have no conflict of interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Erman Aytac, MD, FTBS, Assistant Professor of Surgery, Department of General Surgery, Medical School, Acibadem University, Büyükdere Cd. No:40 Maslak, Istanbul 34457, Turkey. ermanaytac@gmail.com
Telephone: +90-533-4144405
Received: January 26, 2016
Peer-review started: January 27, 2016
First decision: March 23, 2016
Revised: January 3, 2017
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: April 16, 2017
Processing time: 444 Days and 7.4 Hours
Abstract

Crohn’s disease (CD) is a chronic inflammatory disease of digestive tract. Approximately 70% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However, laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD, which are also complicating laparoscopic treatments. Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.

Keywords: Crohn’s disease; Laparoscopic surgery; Complex disease management; Recurrent Crohn’s disease

Core tip: Despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids, approximately 70% of patients with Crohn’s disease (CD) require surgical intervention within 10 years of their initial diagnosis. Forty percent to 50% of patients who had an index surgery for CD require a reoperation for recurrent disease in 10 years. Index surgical treatment type and medications used after index surgery appears to be factors related to recurrence risk of CD. In experienced hands, laparoscopic approach has promising outcomes in patients with recurrent CD when it is used selectively.