Skip to main content
Top
Published in: Diseases of the Colon & Rectum 5/2007

01-05-2007

Laparoscopic Surgery for Crohn’s Disease: A Meta-Analysis

Authors: Jane J. Y. Tan, M.B.B.S., M.R.C.S., Joe J. Tjandra, M.D., F.R.A.C.S.

Published in: Diseases of the Colon & Rectum | Issue 5/2007

Login to get access

Purpose

This study was designed to determine the safety and feasibility of laparoscopic surgery in Crohn’s disease.

Methods

A search of published studies in English between January 1990 and February 2006 was performed by using the MEDLINE and PubMed databases and the Cochrane Central Register of Controlled Trials. The studies were reviewed by two independent assessors. Meta-analysis with the Forest plot was performed when raw data, means, and standard deviations were available.

Results

The rate of conversion from laparoscopic to open surgery was 11.2 percent. Laparoscopic procedures took longer to perform compared with open procedures, with a weighted mean difference of 25.54 minutes (P = 0.03). Patients who underwent laparoscopic surgery had a more rapid recovery of bowel function, with a weighted mean difference of 0.75 days (P = 0.02) and were able to tolerate oral intake earlier, with a weighted mean difference of 1.43 days (P = 0.0008). The duration of hospitalization was shorter, with a weighted mean difference of 1.82 days (P = 0.02). Morbidity was lower for laparoscopic procedures compared with open procedures (odds ratio, 0.57; 95 percent confidence interval, 0.37–0.87; P = 0.01). The rate of disease recurrence was similar for both laparoscopic and open surgery.

Conclusions

Laparoscopic surgery for Crohn’s disease takes longer to perform, but there are significant short-term benefits to the patient. The morbidity also is lower, and the rate of disease recurrence is similar. Therefore, laparoscopic surgery for Crohn’s disease is both safe and feasible.
Literature
1.
go back to reference Milsom, JW 2005Laparoscopic surgery in the treatment of Crohn’s disease.Surg Clin North Am852534PubMedCrossRef Milsom, JW 2005Laparoscopic surgery in the treatment of Crohn’s disease.Surg Clin North Am852534PubMedCrossRef
2.
go back to reference Zmora, O 2003Laparoscopy for Crohn’s disease.Semin Laparosc Surg1015967PubMed Zmora, O 2003Laparoscopy for Crohn’s disease.Semin Laparosc Surg1015967PubMed
3.
go back to reference RevMan User Guideline. Review Manager (RevMan) [Computer program] Version 4.2 for Windows. Oxford, England: The Cochrane Collaboration 2002. RevMan User Guideline. Review Manager (RevMan) [Computer program] Version 4.2 for Windows. Oxford, England: The Cochrane Collaboration 2002.
5.
go back to reference Egger, M, Davey Smith, G, Schneider, M, Minder, C 1997Bias in meta-analysis detected by a simple graphic test.BMJ31562934PubMed Egger, M, Davey Smith, G, Schneider, M, Minder, C 1997Bias in meta-analysis detected by a simple graphic test.BMJ31562934PubMed
6.
go back to reference Alabaz, O, Iroatulam, AJ, Nessim, A, Weiss, EG, Nogueras, JJ, Wexner, SD 2000Comparison of laparoscopically assisted and conventional ileocolic resection for Crohn’s disease.Eur J Surg166213217PubMedCrossRef Alabaz, O, Iroatulam, AJ, Nessim, A, Weiss, EG, Nogueras, JJ, Wexner, SD 2000Comparison of laparoscopically assisted and conventional ileocolic resection for Crohn’s disease.Eur J Surg166213217PubMedCrossRef
7.
go back to reference Bemelman, WA, Slors, JF, Dunker, MS, et al. 2000Laparoscopic-assisted vs open ileocolic resection for Crohn’s disease - a comparative study.Surg Endosc14721725PubMedCrossRef Bemelman, WA, Slors, JF, Dunker, MS,  et al. 2000Laparoscopic-assisted vs open ileocolic resection for Crohn’s disease - a comparative study.Surg Endosc14721725PubMedCrossRef
8.
go back to reference Benoist, S, Panis, Y, Beaufour, A, Bouhnik, Y, Matuchansky, C, Valleur, P 2003Laparoscopic ileocecal resection in Crohn’s disease - a case-matched comparison with open resection.Surg Endosc17814818PubMedCrossRef Benoist, S, Panis, Y, Beaufour, A, Bouhnik, Y, Matuchansky, C, Valleur, P 2003Laparoscopic ileocecal resection in Crohn’s disease - a case-matched comparison with open resection.Surg Endosc17814818PubMedCrossRef
9.
go back to reference Bergamaschi, R, Pessaux, P, Arnaud, JP 2003Comparison of conventional and laparoscopic ileocolic resection for Crohn’s disease.Dis Colon Rectum4611291133PubMedCrossRef Bergamaschi, R, Pessaux, P, Arnaud, JP 2003Comparison of conventional and laparoscopic ileocolic resection for Crohn’s disease.Dis Colon Rectum4611291133PubMedCrossRef
10.
go back to reference Duepree, HJ, Senagore, AJ, Delaney, CP, Brady, KM, Fazio, VW 2002Advantages of laparoscopic resection for ileocecal Crohn’s disease.Dis Colon Rectum45605610PubMedCrossRef Duepree, HJ, Senagore, AJ, Delaney, CP, Brady, KM, Fazio, VW 2002Advantages of laparoscopic resection for ileocecal Crohn’s disease.Dis Colon Rectum45605610PubMedCrossRef
11.
go back to reference Huilgol, RL, Wright, CM, Solomon, MJ 2004Laparoscopic versus open ileocolic resection for Crohn’s disease.J Laparoendosc Adv Surg Tech A146165PubMedCrossRef Huilgol, RL, Wright, CM, Solomon, MJ 2004Laparoscopic versus open ileocolic resection for Crohn’s disease.J Laparoendosc Adv Surg Tech A146165PubMedCrossRef
12.
go back to reference Luan, XJ, Gross, E 2000Laparoscopic assisted surgery for Crohn’s disease an initial experience and results.J Tongji Med Univ20332335PubMedCrossRef Luan, XJ, Gross, E 2000Laparoscopic assisted surgery for Crohn’s disease an initial experience and results.J Tongji Med Univ20332335PubMedCrossRef
13.
go back to reference Maartense, S, Dunker, MS, Slors, JF, et al. 2006Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease, a randomized trial.Ann Surg243143149PubMedCrossRef Maartense, S, Dunker, MS, Slors, JF,  et al. 2006Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease, a randomized trial.Ann Surg243143149PubMedCrossRef
14.
go back to reference Milsom, JW, Hammerhofer, KA, Bohm, B, Marcello, P, Elson, P, Fazio, VW 2001Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease.Dis Colon Rectum4419PubMedCrossRef Milsom, JW, Hammerhofer, KA, Bohm, B, Marcello, P, Elson, P, Fazio, VW 2001Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease.Dis Colon Rectum4419PubMedCrossRef
15.
go back to reference Msika, S, Iannelli, A, Deroide, G, et al. 2001Can laparoscopy reduce hospital stay in the treatment of Crohn’s disease?Dis Colon Rectum 2001;4416611666CrossRef Msika, S, Iannelli, A, Deroide, G,  et al. 2001Can laparoscopy reduce hospital stay in the treatment of Crohn’s disease?Dis Colon Rectum 2001;4416611666CrossRef
16.
go back to reference Shore, G, Gonzalez, QH, Bondora, A, Vickers, SM 2003Laparoscopic vs conventional ileocolectomy for primary Crohn’s disease.Arch Surg1387679PubMedCrossRef Shore, G, Gonzalez, QH, Bondora, A, Vickers, SM 2003Laparoscopic vs conventional ileocolectomy for primary Crohn’s disease.Arch Surg1387679PubMedCrossRef
17.
go back to reference Tabet, J, Hong, D, Kim, CW, Wong, J, Goodacre, R, Anvari, M 2001Laparoscopic versus open bowel resection for Crohn’s disease.Can J Gastroenterol15237242PubMed Tabet, J, Hong, D, Kim, CW, Wong, J, Goodacre, R, Anvari, M 2001Laparoscopic versus open bowel resection for Crohn’s disease.Can J Gastroenterol15237242PubMed
18.
go back to reference Wu, JS, Birnbaum, EH, Kodner, IJ, Fry, RD, Read, TE, Fleshman, JW 1997Laparoscopic-assisted ileocolic resections in patients with Crohn’s disease: are abscesses, phlegmons or recurrent disease contraindications?Surgery122682689PubMedCrossRef Wu, JS, Birnbaum, EH, Kodner, IJ, Fry, RD, Read, TE, Fleshman, JW 1997Laparoscopic-assisted ileocolic resections in patients with Crohn’s disease: are abscesses, phlegmons or recurrent disease contraindications?Surgery122682689PubMedCrossRef
19.
go back to reference Young-Fadok, TM, Hall Long, K, McConnell, EJ, Gomez Rey, G, Cabanela, RL 2001Advantages of laparoscopic resection for ileocolic Crohn’s disease - improved outcomes and reduced costs.Surg Endosc15450454PubMedCrossRef Young-Fadok, TM, Hall Long, K, McConnell, EJ, Gomez Rey, G, Cabanela, RL 2001Advantages of laparoscopic resection for ileocolic Crohn’s disease - improved outcomes and reduced costs.Surg Endosc15450454PubMedCrossRef
20.
go back to reference Motson, RW, Kadirkamanathan, SS, Gallegos, N 2002Minimally invasive surgery for ileo-colic Crohn’s disease.Colorectal Dis4127131PubMedCrossRef Motson, RW, Kadirkamanathan, SS, Gallegos, N 2002Minimally invasive surgery for ileo-colic Crohn’s disease.Colorectal Dis4127131PubMedCrossRef
21.
go back to reference Ludwig, KA, Milsom, JW, Church, JM, Fazio, VW 1996Preliminary experience with laparoscopic intestinal surgery for Crohn’s disease.Am J Surg1715256PubMedCrossRef Ludwig, KA, Milsom, JW, Church, JM, Fazio, VW 1996Preliminary experience with laparoscopic intestinal surgery for Crohn’s disease.Am J Surg1715256PubMedCrossRef
22.
go back to reference Bauer, JJ, Harris, MT, Grumbach, NM, Gorfine, SR 1995Laparoscopic-assisted intestinal resection for Crohn’s disease.Dis Colon Rectum38712715PubMedCrossRef Bauer, JJ, Harris, MT, Grumbach, NM, Gorfine, SR 1995Laparoscopic-assisted intestinal resection for Crohn’s disease.Dis Colon Rectum38712715PubMedCrossRef
23.
go back to reference Hamel, CT, Hildebrnadt, U, Weiss, EG, Feifelz, G, Wexner, SD 2001Laparoscopic surgery for inflammatory bowel disease.Surg Endosc15642645PubMedCrossRef Hamel, CT, Hildebrnadt, U, Weiss, EG, Feifelz, G, Wexner, SD 2001Laparoscopic surgery for inflammatory bowel disease.Surg Endosc15642645PubMedCrossRef
24.
go back to reference Watanabe, M, Hasegawa, H, Yamamoto, S, Hibi, T, Kitajima, M 2002Successful application of laparoscopic surgery to the treatment of Crohn’s disease with fistulas.Dis Colon Rectum4510571061PubMedCrossRef Watanabe, M, Hasegawa, H, Yamamoto, S, Hibi, T, Kitajima, M 2002Successful application of laparoscopic surgery to the treatment of Crohn’s disease with fistulas.Dis Colon Rectum4510571061PubMedCrossRef
25.
go back to reference Schmidt, CM, Talamini, MA, Kaufman, HS, Lilliemoe, KD, Learn, P, Bayless, T 2001Laparoscopic surgery for Crohn’s disease: reasons for conversion.Ann Surg233733739PubMedCrossRef Schmidt, CM, Talamini, MA, Kaufman, HS, Lilliemoe, KD, Learn, P, Bayless, T 2001Laparoscopic surgery for Crohn’s disease: reasons for conversion.Ann Surg233733739PubMedCrossRef
26.
go back to reference Reissman, P, Salky, B, Edye, M, Wexner, SD 1996Laparoscopic surgery in Crohn’s disease-indications and results.Surg Endosc1012011204PubMedCrossRef Reissman, P, Salky, B, Edye, M, Wexner, SD 1996Laparoscopic surgery in Crohn’s disease-indications and results.Surg Endosc1012011204PubMedCrossRef
27.
go back to reference Evans, J, Poritz, L, MacRae, H 2002Influence of experience on laparoscopic ileocolic resection for Crohn’s disease.Dis Colon Rectum4515951600PubMedCrossRef Evans, J, Poritz, L, MacRae, H 2002Influence of experience on laparoscopic ileocolic resection for Crohn’s disease.Dis Colon Rectum4515951600PubMedCrossRef
28.
go back to reference Hamel, CT, Pikarsky, AL, Wexner, SD 2002Laparoscopically assisted hemicolectomy for Crohn’s disease: are we still getting better?Am Surg688386PubMed Hamel, CT, Pikarsky, AL, Wexner, SD 2002Laparoscopically assisted hemicolectomy for Crohn’s disease: are we still getting better?Am Surg688386PubMed
29.
go back to reference Canin-Endres, J, Salky, B, Gattorno, F, Edye, M 1999Laparoscopically assisted intestinal resection in 88 patients with Crohn’s disease.Surg Endosc13595599PubMedCrossRef Canin-Endres, J, Salky, B, Gattorno, F, Edye, M 1999Laparoscopically assisted intestinal resection in 88 patients with Crohn’s disease.Surg Endosc13595599PubMedCrossRef
30.
go back to reference Moorthy, K, Shaul, T, Foley, RJ 2004Factors that predict conversion in patients undergoing laparoscopic surgery for Crohn’s disease.Am J Surg1874751PubMedCrossRef Moorthy, K, Shaul, T, Foley, RJ 2004Factors that predict conversion in patients undergoing laparoscopic surgery for Crohn’s disease.Am J Surg1874751PubMedCrossRef
31.
go back to reference Hasegawa, H, Watanabe, M, Nishibori, H, Okabayashi, K, Hibi, T, Kitajima, M 2003Laparoscopic surgery for recurrent Crohn’s disease.Br J Surg90970973PubMedCrossRef Hasegawa, H, Watanabe, M, Nishibori, H, Okabayashi, K, Hibi, T, Kitajima, M 2003Laparoscopic surgery for recurrent Crohn’s disease.Br J Surg90970973PubMedCrossRef
32.
go back to reference Alves, A, Panis, Y, Bouhnik, Y, et al. 2005Factors that predict conversion in 69 consecutive patients undergoing laparoscopic ileocecal resection for Crohn’s disease: a prospective study.Dis Colon Rectum4823022308PubMedCrossRef Alves, A, Panis, Y, Bouhnik, Y,  et al. 2005Factors that predict conversion in 69 consecutive patients undergoing laparoscopic ileocecal resection for Crohn’s disease: a prospective study.Dis Colon Rectum4823022308PubMedCrossRef
33.
go back to reference Bemelman, WA, van Hogezand, RA, Meijerink, WJ, Griffioen, G, Ringers, J 1998Laparoscopic-assisted bowel resections in inflammatory bowel disease: state of the art.Neth J Med53S39S46PubMedCrossRef Bemelman, WA, van Hogezand, RA, Meijerink, WJ, Griffioen, G, Ringers, J 1998Laparoscopic-assisted bowel resections in inflammatory bowel disease: state of the art.Neth J Med53S39S46PubMedCrossRef
34.
go back to reference Davies, W, Kollmorgen, CF, Tu, QM, et al. 1997Laparoscopic colectomy shortens postoperative ileus in a canine model.Surgery121550555PubMedCrossRef Davies, W, Kollmorgen, CF, Tu, QM,  et al. 1997Laparoscopic colectomy shortens postoperative ileus in a canine model.Surgery121550555PubMedCrossRef
35.
go back to reference Dunker, MS, Stiggelbout, AM, van Hogezand, RA, Ringers, J, Griffioen, G, Bemelman, WA 1998Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease.Surg Endosc1213341340PubMedCrossRef Dunker, MS, Stiggelbout, AM, van Hogezand, RA, Ringers, J, Griffioen, G, Bemelman, WA 1998Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease.Surg Endosc1213341340PubMedCrossRef
36.
go back to reference Delaney, CP, Kiran, RP, Senagore, AJ, et al. 2003Quality of life improves within 30 days of surgery for Crohn’s disease.J Am Coll Surg196714721PubMedCrossRef Delaney, CP, Kiran, RP, Senagore, AJ,  et al. 2003Quality of life improves within 30 days of surgery for Crohn’s disease.J Am Coll Surg196714721PubMedCrossRef
37.
go back to reference Thaler, K, Dinnewitzer, A, Oberwalder, M, Weiss, EG, Nogueras, JJ, Wexner, SD 2005Assessment of long-term quality of life after laparoscopic and open surgery for Crohn’s disease.Colorectal Dis7375381PubMedCrossRef Thaler, K, Dinnewitzer, A, Oberwalder, M, Weiss, EG, Nogueras, JJ, Wexner, SD 2005Assessment of long-term quality of life after laparoscopic and open surgery for Crohn’s disease.Colorectal Dis7375381PubMedCrossRef
38.
go back to reference Delaney, CP, Kiran, RP, Senagore, AJ, Brady, K, Fazio, VW 2003Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery.Ann Surg2386772PubMedCrossRef Delaney, CP, Kiran, RP, Senagore, AJ, Brady, K, Fazio, VW 2003Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery.Ann Surg2386772PubMedCrossRef
39.
go back to reference Lowney, JK, Dietz, DW, Birnbaum, EH, Kodner, IJ, Mutch, MG, Fleshman, JW 2006Is there any difference in recurrence rates in laparoscopic ileocolic resection for Crohn’s disease compared with conventional surgery? A long-term, follow-up study.Dis Colon Rectum495863PubMedCrossRef Lowney, JK, Dietz, DW, Birnbaum, EH, Kodner, IJ, Mutch, MG, Fleshman, JW 2006Is there any difference in recurrence rates in laparoscopic ileocolic resection for Crohn’s disease compared with conventional surgery? A long-term, follow-up study.Dis Colon Rectum495863PubMedCrossRef
40.
go back to reference Reissman, P, Cohen, S, Weiss, EG, Wexner, SD, Lointier, PH 1996Laparoscopic colorectal surgery: ascending the learning curve.World J Surg20277282PubMedCrossRef Reissman, P, Cohen, S, Weiss, EG, Wexner, SD, Lointier, PH 1996Laparoscopic colorectal surgery: ascending the learning curve.World J Surg20277282PubMedCrossRef
41.
go back to reference Senagore, AJ, Luchtefeld, MA, Mackeigan, JM 1995What is the learning curve for laparoscopic colectomy?Am Surg61681685PubMed Senagore, AJ, Luchtefeld, MA, Mackeigan, JM 1995What is the learning curve for laparoscopic colectomy?Am Surg61681685PubMed
Metadata
Title
Laparoscopic Surgery for Crohn’s Disease: A Meta-Analysis
Authors
Jane J. Y. Tan, M.B.B.S., M.R.C.S.
Joe J. Tjandra, M.D., F.R.A.C.S.
Publication date
01-05-2007
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 5/2007
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-006-0855-0

Other articles of this Issue 5/2007

Diseases of the Colon & Rectum 5/2007 Go to the issue