Laparoscopically assisted ileo-colonic resection in patients with Crohn's disease--preliminary report.

UNLABELLED: Despite increasing number of reports indicating good treatment outcomes, laparoscopic treatment of Crohn's disease remains controversial. The aim of the study was to compare outcomes of laparoscopically assisted and open ileo-colonic resection in patients with active Crohn's disease. MATERIAL AND METHODS: 82 patients who underwent surgical treatment (44 laparoscopic and 38 open procedures) at the Department of General, Oncological and Gastrointestinal Surgery in Warsaw were enrolled to the study. The following perioperative parameters were compared in both these groups: duration of hospitalization and presence of postoperative complications in at least 12 months of follow-up. RESULTS: The conversion rate in the laparoscopy group was 29.5%. There were no statistically significant differences between the study groups with regard to duration of the surgical procedure, requirement for perioperative transfusions and total number of postoperative complications (19.3% in the laparoscopy group versus 28.9% in the open surgery group). However, amount of analgesic drugs required in the postoperative period was significantly lower (25 ± 6 vs 43 ± 9, p < 0.01) and duration of hospitalization was significantly shorter (9.0 vs 11.3 days, p = 0.021) after laparoscopic versus open procedures procedures. Most of the patients with complicated Crohn's disease who were qualified to laparoscopic treatment, underwent successful treatment using this method. Patients in whom conversion was done, were more likely to be on long term preoperative immunosuppressive therapy versus other patients. CONCLUSIONS: Laparoscopy is a demanding procedure from the technical point of view, but provides valuable benefits to patients with Crohn's disease, including those with a complicated disease. However, this method requires ongoing improvement of technical aspects and thorough analysis of failures to identify factors that could accurately select patients with indications and contraindications to this procedure.

[Management of colonoscopic perforations of large bowel]. / Leczenie kolonoskopowych perforacji jelita grubego.

UNLABELLED: Perforation of large bowel during elective colonoscopy is rare but serious life threatening complication. Early diagnosis of perforation during or soon after colonoscopy shortens time of peritoneal contamination and allows to get good results of surgical treatment. The aims of this study were to determine the incidence of perforation due to colonoscopy in our hospital and to assess methods and results of surgical treatment. MATERIAL AND METHODS: We reviewed our prospectively collected data of 957 patients operated on because of colorectal diseases in the period from January 2003 to December 2010. Data of 16 patients (1.7%) aged from 22 to 89 years of life (average age 67.5 years) operated on because of colonoscopic perforations were analysed. RESULTS: Perforation of large bowel occurred in 9 patients (0.13%) of 6570 persons colonoscopised in our hospital. All 16 patients were operated on in the period of 0.5-32 hours since colonoscopy was performed. Simple suture of the laesion was the most common procedure performed in 12 patients (4 of them had proximal colostomies performed as well). Postoperative complications occurred in 3 patients (18.7%). Nobody died--mortality 0. Average time of hospital postoperative stay was 8.3 days. CONCLUSIONS: Colonoscopic perforation of large bowel requires surgical treatment. Choice of repair method depends on diameter of perforation, time since onset to operation passed, spread and degree of peritoneal contamination and general patient's condition.