Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Nov 27, 2021; 13(11): 1414-1422
Published online Nov 27, 2021. doi: 10.4240/wjgs.v13.i11.1414
Laparoscopic vs open surgery in ileostomy reversal in Crohn’s disease: A retrospective study
Jian Wan, Xiao-Qi Yuan, Tian-Qi Wu, Mu-Qing Yang, Xiao-Cai Wu, Ren-Yuan Gao, Lu Yin, Chun-Qiu Chen
Jian Wan, Xiao-Qi Yuan, Tian-Qi Wu, 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, School of Medicine, Tongji University, Shanghai 200092, China
Author contributions: Wan J reviewed the literature and drafted the manuscript; Yuan XQ and Wu TQ contributed to data analysis; Wan J, Yuan XQ, Wu TQ, Yang MQ, Yin L, and Chen CQ performed the surgery; Chen CQ, Wu XC, and Gao RY made revision to the manuscript; all authors have approved the submission of this manuscript.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the Shanghai Tenth People’s Hospital Affiliated to the Tongji University School of Medicine (approval No. 21K53).
Informed consent statement: Given that the research was retrospective, the requirement for informed patient consent was waived.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this article.
Data sharing statement: No additional data are available.
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, School of Medicine, Tongji University, No. 301 Yanchangzhong Road, Shanghai 200092, China. chenchunqiu6@126.com
Received: April 25, 2021
Peer-review started: April 25, 2021
First decision: July 15, 2021
Revised: July 23, 2021
Accepted: September 8, 2021
Article in press: September 8, 2021
Published online: November 27, 2021
Processing time: 215 Days and 3.1 Hours
Abstract
BACKGROUND

Although minimally invasive surgery is becoming more commonly applied for ileostomy reversal (IR), there have been relatively few studies of IR for patients with Crohn's disease (CD). It is therefore important to evaluate the potential benefits and risks of laparoscopy for patients with CD.

AIM

To compare the safety, feasibility, and short-term and long-term outcomes of laparoscopic IR (LIR) vs open IR (OIR) for the treatment of CD.

METHODS

The baseline characteristics, operative data, and short-term (30-d) and long-term outcomes of patients with CD who underwent LIR and OIR at our institution between January 2017 and January 2020 were retrieved from an electronic database and retrospectively reviewed.

RESULTS

Of the 60 patients enrolled in this study, LIR was performed for 48 and OIR for 12. There were no statistically significant differences in baseline characteristics, operation time, intraoperative blood loss, days to flatus and soft diet, postoperative complications, hospitalization time, readmission rate within 30 d, length of hospitalization, hospitalization costs, or reoperation rate after IR between the two groups. However, patients in the LIR group more frequently required lysis of adhesions as compared to those in the OIR group (87.5% vs 41.7%, respectively, P < 0.05). Notably, following exclusion of patients who underwent enterectomy plus IR, OIR was more advantageous in terms of postoperative recovery of gastrointestinal function and hospitalization costs.

CONCLUSION

The safety and feasibility of LIR for the treatment of CD are comparable to those of OIR with no increase in intraoperative or postoperative complications.

Keywords: Crohn’s disease; Laparoscopy; Ileostomy reversal; Intestinal adhesion; Enterolysis; Faster recovery

Core Tip: Laparoscopic surgery has been shown to promote faster recovery, decrease postoperative pain and morbidity, and improve postoperative quality of life. For Crohn’s disease (CD) patients who require IR, laparoscopy greatly improves the rate of enterolysis and reduces the incidence of ileus. Meanwhile, laparoscopy can effectively explore the entire gastrointestinal tract to identify strictures within short segments of the small bowel, while avoiding large incisions. The aim of the present study was to compare the operative data and short-term and long-term outcomes of laparoscopic ileostomy reversal vs open ileostomy reversal to explore the safety and feasibility of laparoscopic ileostomy reversal for CD.