Laparoscopy for Crohn's disease:A comprehensive exploration of minimally invasive surgical techniques

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.

Laparoscopic vs open surgery in ileostomy reversal in Crohn’s disease:A retrospective study

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.

Minimally invasive surgery for glycogen storage disease combined with inflammatory bowel disease:A case report

BACKGROUND Inflammatory bowel disease(IBD)is rare in patients with glycogen storage disease(GSD).In GSD patients,a decrease in the number of neutrophils leads to prolonged intestinal infection,leading to the formation of chronic inflammation and eventually the development of IBD.Minimally invasive surgery for patients with IBD has been proven to reduce inflammatory responses and postoperative risks and ultimately promote rapid recovery.Herein we discuss minimally invasive surgery and the perioperative management in a patient with GSD and IBD.CASE SUMMARY A 23-year-old male had GSD Ib associated with IBD-like disease for 10 years.Despite standard treatments,such as mesalazine,prednisone and adalimumab,the patient eventually developed colonic stenosis with incomplete ileus.After adequate assessment,the patient was treated with minimally invasive surgery and discharged in stable condition.CONCLUSION Minimally invasive surgery for patients with IBD and GSD is safe,feasible and effective.