Laparoscopic-assisted versus conventional ileocolectomy for primary Crohn's disease: results of a comparative study.
Identifieur interne : 000175 ( Main/Exploration ); précédent : 000174; suivant : 000176Laparoscopic-assisted versus conventional ileocolectomy for primary Crohn's disease: results of a comparative study.
Auteurs : A. Makni [Tunisie] ; F. Chebbi ; R. Ksantini ; F. Fétirich ; H. Bedioui ; M. Jouini ; M. Kacem ; N. Ben Mami ; A. Filali ; Z. Ben SaftaSource :
- Journal of visceral surgery [ 1878-7886 ] ; 2013.
Descripteurs français
- KwdFr :
- Adulte (MeSH), Colectomie (méthodes), Complications postopératoires (épidémiologie), Conversion en chirurgie ouverte (statistiques et données numériques), Durée du séjour (statistiques et données numériques), Durée opératoire (MeSH), Estimation de Kaplan-Meier (MeSH), Femelle (MeSH), Humains (MeSH), Iléum (chirurgie), Laparoscopie (MeSH), Maladie de Crohn (chirurgie), Mâle (MeSH), Récidive (MeSH), Résultat thérapeutique (MeSH), Survie sans rechute (MeSH), Études de suivi (MeSH), Études rétrospectives (MeSH).
- MESH :
- chirurgie : Iléum, Maladie de Crohn.
- méthodes : Colectomie.
- statistiques et données numériques : Conversion en chirurgie ouverte, Durée du séjour.
- épidémiologie : Complications postopératoires.
- Adulte, Durée opératoire, Estimation de Kaplan-Meier, Femelle, Humains, Laparoscopie, Mâle, Récidive, Résultat thérapeutique, Survie sans rechute, Études de suivi, Études rétrospectives.
English descriptors
- KwdEn :
- Adult (MeSH), Colectomy (methods), Conversion to Open Surgery (statistics & numerical data), Crohn Disease (surgery), Disease-Free Survival (MeSH), Female (MeSH), Follow-Up Studies (MeSH), Humans (MeSH), Ileum (surgery), Kaplan-Meier Estimate (MeSH), Laparoscopy (MeSH), Length of Stay (statistics & numerical data), Male (MeSH), Operative Time (MeSH), Postoperative Complications (epidemiology), Recurrence (MeSH), Retrospective Studies (MeSH), Treatment Outcome (MeSH).
- MESH :
- epidemiology : Postoperative Complications.
- methods : Colectomy.
- statistics & numerical data : Conversion to Open Surgery, Length of Stay.
- surgery : Crohn Disease, Ileum.
- Adult, Disease-Free Survival, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Laparoscopy, Male, Operative Time, Recurrence, Retrospective Studies, Treatment Outcome.
Abstract
INTRODUCTION
The laparoscopic approach is becoming the gold standard in the surgical treatment of primary Crohn's disease. The aim of this study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease.
METHODS
We conducted a non-randomized, comparative, retrospective analysis of a prospective database from 1998 to 2010. The remaining 129 patients were divided into two groups: laparoscopic-assisted group (Group L; n=64) and conventional group (Group C; n=65). There were no differences between the two groups as regards preoperative patient characteristics. Complications were graded according to the Clavien-Dindo classification.
RESULTS
One hundred and seventeen (90.7%) patients had no complications. Out of 12 patients (9.3%) with complications, four (3.1%) had Grade I, six (4.7%) had Grade II and two (1.6%) had Grade III. There were no postoperative deaths (Grade V). Operating time was longer in Group L compared with Group C (P<0.001). Bowel function returned more quickly in the laparoscopic group in terms of return of bowel movements (P=0.018) and resumption of a regular diet (P=0.06). The mean length of stay was significantly shorter in the laparoscopic group (P=0.001). The mean follow-up was 26 months in Group L versus 34 months in Group C (P=0.06). During follow-up, six patients presented with small bowel obstruction in Group C, which was not statistically different from Group L (3 patients) (P=0.25). During the follow-up period, there have been no recurrences of Crohn's disease in the laparoscopic group while 11 patients (16.9%) have developed a recurrence in the conventional group (P=0.001).
CONCLUSION
Laparoscopic-assisted ileocolectomy for primary Crohn's disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn's disease should be considered as the preferred operative approach for primary resections.
DOI: 10.1016/j.jviscsurg.2012.10.006
PubMed: 23092647
Affiliations:
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Ksantini</name></author><author><name sortKey="Fetirich, F" sort="Fetirich, F" uniqKey="Fetirich F" first="F" last="Fétirich">F. Fétirich</name></author><author><name sortKey="Bedioui, H" sort="Bedioui, H" uniqKey="Bedioui H" first="H" last="Bedioui">H. Bedioui</name></author><author><name sortKey="Jouini, M" sort="Jouini, M" uniqKey="Jouini M" first="M" last="Jouini">M. Jouini</name></author><author><name sortKey="Kacem, M" sort="Kacem, M" uniqKey="Kacem M" first="M" last="Kacem">M. Kacem</name></author><author><name sortKey="Ben Mami, N" sort="Ben Mami, N" uniqKey="Ben Mami N" first="N" last="Ben Mami">N. Ben Mami</name></author><author><name sortKey="Filali, A" sort="Filali, A" uniqKey="Filali A" first="A" last="Filali">A. Filali</name></author><author><name sortKey="Ben Safta, Z" sort="Ben Safta, Z" uniqKey="Ben Safta Z" first="Z" last="Ben Safta">Z. 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Makni</name><affiliation wicri:level="3"><nlm:affiliation>Department of General Surgery 'A', La Rabta Hospital, Tunis, Tunisia. aminmakni@msn.com</nlm:affiliation><country xml:lang="fr">Tunisie</country><wicri:regionArea>Department of General Surgery 'A', La Rabta Hospital, Tunis</wicri:regionArea><placeName><settlement type="city">Tunis</settlement><region nuts="2">Gouvernorat de Tunis</region></placeName></affiliation></author><author><name sortKey="Chebbi, F" sort="Chebbi, F" uniqKey="Chebbi F" first="F" last="Chebbi">F. Chebbi</name></author><author><name sortKey="Ksantini, R" sort="Ksantini, R" uniqKey="Ksantini R" first="R" last="Ksantini">R. Ksantini</name></author><author><name sortKey="Fetirich, F" sort="Fetirich, F" uniqKey="Fetirich F" first="F" last="Fétirich">F. Fétirich</name></author><author><name sortKey="Bedioui, H" sort="Bedioui, H" uniqKey="Bedioui H" first="H" last="Bedioui">H. Bedioui</name></author><author><name sortKey="Jouini, M" sort="Jouini, M" uniqKey="Jouini M" first="M" last="Jouini">M. Jouini</name></author><author><name sortKey="Kacem, M" sort="Kacem, M" uniqKey="Kacem M" first="M" last="Kacem">M. Kacem</name></author><author><name sortKey="Ben Mami, N" sort="Ben Mami, N" uniqKey="Ben Mami N" first="N" last="Ben Mami">N. Ben Mami</name></author><author><name sortKey="Filali, A" sort="Filali, A" uniqKey="Filali A" first="A" last="Filali">A. Filali</name></author><author><name sortKey="Ben Safta, Z" sort="Ben Safta, Z" uniqKey="Ben Safta Z" first="Z" last="Ben Safta">Z. Ben Safta</name></author></analytic><series><title level="j">Journal of visceral surgery</title><idno type="eISSN">1878-7886</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term><term>Colectomy (methods)</term><term>Conversion to Open Surgery (statistics & numerical data)</term><term>Crohn Disease (surgery)</term><term>Disease-Free Survival (MeSH)</term><term>Female (MeSH)</term><term>Follow-Up Studies (MeSH)</term><term>Humans (MeSH)</term><term>Ileum (surgery)</term><term>Kaplan-Meier Estimate (MeSH)</term><term>Laparoscopy (MeSH)</term><term>Length of Stay (statistics & numerical data)</term><term>Male (MeSH)</term><term>Operative Time (MeSH)</term><term>Postoperative Complications (epidemiology)</term><term>Recurrence (MeSH)</term><term>Retrospective Studies (MeSH)</term><term>Treatment Outcome (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte (MeSH)</term><term>Colectomie (méthodes)</term><term>Complications postopératoires (épidémiologie)</term><term>Conversion en chirurgie ouverte (statistiques et données numériques)</term><term>Durée du séjour (statistiques et données numériques)</term><term>Durée opératoire (MeSH)</term><term>Estimation de Kaplan-Meier (MeSH)</term><term>Femelle (MeSH)</term><term>Humains (MeSH)</term><term>Iléum (chirurgie)</term><term>Laparoscopie (MeSH)</term><term>Maladie de Crohn (chirurgie)</term><term>Mâle (MeSH)</term><term>Récidive (MeSH)</term><term>Résultat thérapeutique (MeSH)</term><term>Survie sans rechute (MeSH)</term><term>Études de suivi (MeSH)</term><term>Études rétrospectives (MeSH)</term></keywords><keywords scheme="MESH" qualifier="chirurgie" xml:lang="fr"><term>Iléum</term><term>Maladie de Crohn</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Postoperative Complications</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Colectomy</term></keywords><keywords scheme="MESH" qualifier="méthodes" xml:lang="fr"><term>Colectomie</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Conversion to Open Surgery</term><term>Length of Stay</term></keywords><keywords scheme="MESH" qualifier="statistiques et données numériques" xml:lang="fr"><term>Conversion en chirurgie ouverte</term><term>Durée du séjour</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Crohn Disease</term><term>Ileum</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Complications postopératoires</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Disease-Free Survival</term><term>Female</term><term>Follow-Up Studies</term><term>Humans</term><term>Kaplan-Meier Estimate</term><term>Laparoscopy</term><term>Male</term><term>Operative Time</term><term>Recurrence</term><term>Retrospective Studies</term><term>Treatment Outcome</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Durée opératoire</term><term>Estimation de Kaplan-Meier</term><term>Femelle</term><term>Humains</term><term>Laparoscopie</term><term>Mâle</term><term>Récidive</term><term>Résultat thérapeutique</term><term>Survie sans rechute</term><term>Études de suivi</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>INTRODUCTION</b></p><p>The laparoscopic approach is becoming the gold standard in the surgical treatment of primary Crohn's disease. The aim of this study was to compare laparoscopic-assisted and open ileocolic resection for primary Crohn's disease.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>We conducted a non-randomized, comparative, retrospective analysis of a prospective database from 1998 to 2010. The remaining 129 patients were divided into two groups: laparoscopic-assisted group (Group L; n=64) and conventional group (Group C; n=65). There were no differences between the two groups as regards preoperative patient characteristics. Complications were graded according to the Clavien-Dindo classification.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>One hundred and seventeen (90.7%) patients had no complications. Out of 12 patients (9.3%) with complications, four (3.1%) had Grade I, six (4.7%) had Grade II and two (1.6%) had Grade III. There were no postoperative deaths (Grade V). Operating time was longer in Group L compared with Group C (P<0.001). Bowel function returned more quickly in the laparoscopic group in terms of return of bowel movements (P=0.018) and resumption of a regular diet (P=0.06). The mean length of stay was significantly shorter in the laparoscopic group (P=0.001). The mean follow-up was 26 months in Group L versus 34 months in Group C (P=0.06). During follow-up, six patients presented with small bowel obstruction in Group C, which was not statistically different from Group L (3 patients) (P=0.25). During the follow-up period, there have been no recurrences of Crohn's disease in the laparoscopic group while 11 patients (16.9%) have developed a recurrence in the conventional group (P=0.001).</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Laparoscopic-assisted ileocolectomy for primary Crohn's disease of the terminal ileum and/or cecum is safe and successful in most cases. Laparoscopic surgery for Crohn's disease should be considered as the preferred operative approach for primary resections.</p></div></front></TEI><affiliations><list><country><li>Tunisie</li></country><region><li>Gouvernorat de Tunis</li></region><settlement><li>Tunis</li></settlement></list><tree><noCountry><name sortKey="Bedioui, H" sort="Bedioui, H" uniqKey="Bedioui H" first="H" last="Bedioui">H. Bedioui</name><name sortKey="Ben Mami, N" sort="Ben Mami, N" uniqKey="Ben Mami N" first="N" last="Ben Mami">N. Ben Mami</name><name sortKey="Ben Safta, Z" sort="Ben Safta, Z" uniqKey="Ben Safta Z" first="Z" last="Ben Safta">Z. Ben Safta</name><name sortKey="Chebbi, F" sort="Chebbi, F" uniqKey="Chebbi F" first="F" last="Chebbi">F. Chebbi</name><name sortKey="Fetirich, F" sort="Fetirich, F" uniqKey="Fetirich F" first="F" last="Fétirich">F. Fétirich</name><name sortKey="Filali, A" sort="Filali, A" uniqKey="Filali A" first="A" last="Filali">A. Filali</name><name sortKey="Jouini, M" sort="Jouini, M" uniqKey="Jouini M" first="M" last="Jouini">M. Jouini</name><name sortKey="Kacem, M" sort="Kacem, M" uniqKey="Kacem M" first="M" last="Kacem">M. Kacem</name><name sortKey="Ksantini, R" sort="Ksantini, R" uniqKey="Ksantini R" first="R" last="Ksantini">R. Ksantini</name></noCountry><country name="Tunisie"><region name="Gouvernorat de Tunis"><name sortKey="Makni, A" sort="Makni, A" uniqKey="Makni A" first="A" last="Makni">A. Makni</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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