Laparoscopic-assisted intestinal resection for Crohn's disease. Which patients are good candidates?

This study was undertaken to determine preoperative criteria indicating which patients with Crohn's disease are most amenable to minimally invasive intestinal resection. Laparoscopic-assisted intestinal resection was attempted in 25 patients with Crohn's disease. Preoperative assessment of all patients included physical examination and contrast radiography. Laparoscopic intestinal resection was successfully completed in 19 patients. Four patients in whom both palpable mass and fistulous disease were present required conversion to open surgery. One patient found during surgery to have a fistula required conversion, as did one patient who had undergone previous ileocolic resection. In patients treated laparoscopically, oral alimentation, discontinuation of parenteral narcotics, and hospital discharge were possible at an average of 3.4, 4.2, and 6.5 days postsurgery, respectively. Patients operated upon using open techniques stayed in the hospital an average of 8.5 days. Laparoscopic-assisted intestinal resection is beneficial to selected patients with Crohn's disease. The presence of both a fixed mass and fistula on preoperative evaluation is predictive of conversion to open laparotomy and should be considered a relative contraindication. Patients with either a fixed mass or a fistula alone are more amenable to laparoscopic-assisted intestinal resection, while patients with primary uncomplicated Crohn's disease appear to be ideally suited to minimally invasive surgery.