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Robotic and laparoscopic surgical techniques in patients with Crohn’s disease

  • 2020 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Crohn’s disease has historically been managed medically with sparing use of surgical resection. With the development of strictures or fistulas, surgical management such as an ileocecal resection may become necessary. Minimally invasive options such as laparoscopic and robotic-assisted techniques are alternatives to open surgery. The purpose of this study was to evaluate the safety of minimally invasive surgery for Crohn’s disease.

Methods

We performed a retrospective review of the National Surgical Quality Improvement Program (NSQIP) database to select 5158 patients with Crohn’s disease who underwent ileocecal resection (open, laparoscopic, or robotic-assisted). Preoperative, perioperative, and 30-day postoperative outcomes were compared between the groups using both univariate and multivariate logistical regression models. SAS was used for data analysis with p < 0.05 considered significant.

Results

The three treatment groups (open, laparoscopic, and robotic-assisted ileocecal resection) had 30-day postoperative outcomes reported in NSQIP. The average BMI was 25 kg/m2 and the average age was 41. The rate of anastomotic leaks was significantly higher in the open surgery group compared to the minimally invasive groups (p = 0.001). The open surgery group had a significantly higher reoperation rate (p = 0.0002) and wound infection rate (p < 0.0001). The robotic-assisted group had significantly longer operative times compared to the laparoscopic and open groups (p < 0.0001).

Conclusions

The decision to operate on a patient with Crohn’s disease involves selecting an approach based on patient factors, surgeon preference, and availability of equipment. When evaluating the short-term postoperative outcomes in patients that have undergone ileocecal resection for management of Crohn’s, minimally invasive techniques have had a lower incidence of wound infections, anastomotic leaks, and re-intervention in carefully selected patients. This retrospective review of a large national database demonstrates the efficacy of minimally invasive techniques in managing Crohn’s disease in selected patients.

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Authors and Affiliations

  1. Department of Surgery, Eastern Virginia Medical School, 825 Fairfax Ave Ste. 610, Norfolk, VA, 23507, USA

    Salini Hota

  2. Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Salvatore Parascandola

  3. The George Washington University Medical School, Washington, DC, USA

    Savannah Smith

  4. Division of Colorectal Surgery, Philippine General Hospital, Manila, Philippines

    Mayou Martin Tampo

  5. Medical Faculty Associates, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Richard Amdur

  6. Division of Colon and Rectal Surgery, The George Washington University, Washington, DC, USA

    Vincent Obias

Authors
  1. Salini Hota
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  2. Salvatore Parascandola
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  3. Savannah Smith
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  4. Mayou Martin Tampo
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  5. Richard Amdur
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  6. Vincent Obias
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Correspondence to Salini Hota.

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Disclosures

The following authors have no conflicts of interest or financial ties to disclose: Dr. Hota, Dr. Parascandola. Savannah Smith, Dr. Tampo, Dr. Amdur. Dr. Obias is a consultant for MedRobotics.

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Hota, S., Parascandola, S., Smith, S. et al. Robotic and laparoscopic surgical techniques in patients with Crohn’s disease. Surg Endosc 35, 4602–4608 (2021). https://doi.org/10.1007/s00464-020-07885-x

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  • DOI: https://doi.org/10.1007/s00464-020-07885-x

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