TY - JOUR
T1 - Can laparoscopic surgery prevent incisional hernia in patients with Crohn’s disease
T2 - a comparison study of 750 patients undergoing open and laparoscopic bowel resection
AU - Heimann, Tomas M.
AU - Swaminathan, Santosh
AU - Greenstein, Adrian J.
AU - Greenstein, Alexander J.
AU - Khaitov, Sergey
AU - Steinhagen, Randolph M.
AU - Salky, Barry A.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/12/1
Y1 - 2017/12/1
N2 - Background: Incisional hernia (IH) is a frequent occurrence following open surgery for Crohn’s disease (CD). This study compares the IH rates of patients with CD undergoing open versus laparoscopic bowel resection. Methods: Seven hundred and fifty patients with CD operated by the authors at the Mount Sinai Medical Center, New York, USA, were reviewed from a prospectively maintained surgical database. Five hundred patients with Crohn’s disease undergoing open surgery were compared to 250 patients undergoing laparoscopic bowel resection. Results: The mean duration of follow-up in the study population was 6.8 years. Patients undergoing open surgery had a significantly higher age at onset of disease, age at surgery, longer duration of disease, lower serum albumin, history of multiple previous resections, were more likely to be on steroids, needed more blood transfusions, and had an increased necessity for an ileostomy during resection. Nevertheless, the incidence of IH at 36 months was nearly identical in both groups (10.8 vs. 8.4% for open vs laparoscopic). 16% of the patients in the laparoscopic group (range: 7–20%) required conversion to open surgery. Patients undergoing laparoscopic resection that required conversion to open surgery had the highest IH rate at 18%. There was a significant correlation between IH and the length of the midline vertical extraction incision. Patients undergoing laparoscopic resection with intracorporeal anastomosis and small transverse or trocar site extraction incisions had no IH. Conclusions: A marked decrease or complete elimination of IH in patients with CD undergoing bowel resection may be possible using advanced laparoscopic techniques that require intra-abdominal anastomosis and use of the smallest transverse extraction incisions.
AB - Background: Incisional hernia (IH) is a frequent occurrence following open surgery for Crohn’s disease (CD). This study compares the IH rates of patients with CD undergoing open versus laparoscopic bowel resection. Methods: Seven hundred and fifty patients with CD operated by the authors at the Mount Sinai Medical Center, New York, USA, were reviewed from a prospectively maintained surgical database. Five hundred patients with Crohn’s disease undergoing open surgery were compared to 250 patients undergoing laparoscopic bowel resection. Results: The mean duration of follow-up in the study population was 6.8 years. Patients undergoing open surgery had a significantly higher age at onset of disease, age at surgery, longer duration of disease, lower serum albumin, history of multiple previous resections, were more likely to be on steroids, needed more blood transfusions, and had an increased necessity for an ileostomy during resection. Nevertheless, the incidence of IH at 36 months was nearly identical in both groups (10.8 vs. 8.4% for open vs laparoscopic). 16% of the patients in the laparoscopic group (range: 7–20%) required conversion to open surgery. Patients undergoing laparoscopic resection that required conversion to open surgery had the highest IH rate at 18%. There was a significant correlation between IH and the length of the midline vertical extraction incision. Patients undergoing laparoscopic resection with intracorporeal anastomosis and small transverse or trocar site extraction incisions had no IH. Conclusions: A marked decrease or complete elimination of IH in patients with CD undergoing bowel resection may be possible using advanced laparoscopic techniques that require intra-abdominal anastomosis and use of the smallest transverse extraction incisions.
KW - Bowel resection
KW - Crohn’s disease
KW - Incisional hernia
KW - Inflammatory bowel disease
KW - Intracorporeal anastomosis
KW - Laparoscopic surgery
UR - http://www.scopus.com/inward/record.url?scp=85019608482&partnerID=8YFLogxK
U2 - 10.1007/s00464-017-5588-8
DO - 10.1007/s00464-017-5588-8
M3 - Article
C2 - 28523361
AN - SCOPUS:85019608482
VL - 31
SP - 5201
EP - 5208
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
IS - 12
ER -