Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1190-1201
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1190
Laparoscopy for Crohn's disease: A comprehensive exploration of minimally invasive surgical techniques
Jian Wan, Chang Liu, Xiao-Qi Yuan, Mu-Qing Yang, Xiao-Cai Wu, Ren-Yuan Gao, Lu Yin, Chun-Qiu Chen
Jian Wan, Xiao-Qi Yuan, Mu-Qing Yang, Xiao-Cai Wu, Ren-Yuan Gao, Lu Yin, Chun-Qiu Chen, Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai 200072, China
Chang Liu, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai 200072, China
Author contributions: Wan J and Liu C reviewed the literature and drafted the manuscript; Liu C performed the ultrasonic examinations; Yin L and Chen CQ performed the surgeries; Yuan XQ, Yang MQ, Wu XC, and Gao RY assisted during the surgeries; Chen CQ and Yang MQ made revisions to the manuscript; all authors have approved the submission of this manuscript.
Institutional review board statement: The study was reviewed and approved by the Shanghai Tenth People’s Hospital Affiliated to Tongji University School of Medicine.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this article.
Data sharing statement: The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Chun-Qiu Chen, MD, Chief Doctor, Center for Difficult and Complicated Abdominal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchangzhong Road, Shanghai 200072, China. chenchunqiu6@126.com
Received: May 7, 2021
Peer-review started: May 7, 2021
First decision: June 6, 2021
Revised: July 9, 2021
Accepted: September 7, 2021
Article in press: September 7, 2021
Published online: October 27, 2021
Processing time: 171 Days and 18.2 Hours
Abstract
BACKGROUND

Along with the unceasing progress of medicine, Crohn's disease (CD), especially complex CD, is no longer a taboo for minimally invasive surgery. However, considering its special disease characteristics, more clinical trials are needed to confirm the safety and feasibility of laparoscopic surgery for CD.

AIM

To investigate the safety and feasibility of laparoscopic enterectomy for CD, assess the advantages of laparoscopy over laparotomy in patients with CD, and discuss comprehensive minimally invasive surgical techniques in complex CD.

METHODS

This study prospectively collected clinical data from patients with CD who underwent enterectomy from January 2017 to January 2020. It was registered in the Chinese clinical trial database with the registration number ChiCTR-INR-16009321. Patients were divided into a laparoscopy group and a traditional laparotomy group according to the surgical method. The baseline characteristics, operation time, intraoperative blood loss, temporary stoma, levels of abdominal adhesion, pathological characteristics, days to flatus and soft diet, postoperative complications, hospitalization time, readmission rate within 30 d, and hospitalization cost were compared between the two groups.

RESULTS

A total of 120 eligible patients were enrolled into the pre-standardized groups, including 100 in the laparoscopy group and 20 in the laparotomy group. Compared with the laparotomy group, the postoperative hospitalization time in the laparoscopy group was shorter (9.1 ± 3.9 d vs 11.0 ± 1.6 d, P < 0.05), the days to flatus were fewer (2.8 ± 0.8 d vs 3.5 ± 0.7 d, P < 0.05), the days to soft diet were fewer (4.2 ± 2.4 d vs 6.2 ± 2.0 d, P < 0.05) and the intraoperative blood loss was less (103.3 ± 80.42 mL vs 169.5 ± 100.42 mL, P < 0.05). There were no statistically significant differences between the two groups in preoperative clinical data, operation time (149.0 ± 43.8 min vs 159.2 ± 40.0 min), stoma rate, levels of abdominal adhesion, total cost of hospitalization, incidence of postoperative complications [8.0% (8/100) vs 15.0% (3/20)], or readmission rate within 30 days [1.0% (1/100) vs 0.00 (0/20)].

CONCLUSION

Compared with laparotomy, laparoscopic enterectomy promotes the recovery of gastrointestinal function, shortens the postoperative hospitalization time, and does not increase the incidence of postoperative complications. Laparoscopic enterectomy combined with varieties of minimally invasive surgical techniques is a safe and acceptable therapeutic method for CD patients with enteric fistulas.

Keywords: Crohn’s disease; Minimally invasive surgery; Rapid recovery; Inflammatory bowel disease; Ultrasound

Core Tip: The purpose of this research was to investigate the safety, feasibility, and short-term efficacy of laparoscopic enterectomy for Crohn's disease (CD). For this purpose, we analyzed the clinical data of CD patients treated at our center over the past 4 years. Compared with the laparotomy group, the postoperative hospitalization time in the laparoscopy group was shorter, the days to flatus and soft diet were fewer, and the intraoperative blood loss was less. Also, the application of pre-operative ultrasound and intraoperative balloon dilatation for CD was explored specifically in the research.