Long-term outcome of laparoscopic and open surgery in patients with Crohn’s disease
Authors Hoffmann M, Siebrasse D, Schlöricke E, Bouchard R, Keck T, Benecke C
Received 18 May 2017
Accepted for publication 28 July 2017
Published 7 November 2017 Volume 2017:10 Pages 45—54
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Lucy Goodman
Peer reviewer comments 2
Editor who approved publication: Professor Luigi Bonavina
Martin Hoffmann,1 Dina Siebrasse,1 Erik Schlöricke,2 Ralf Bouchard,1 Tobias Keck,1 Claudia Benecke1
1Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, 2Department of Surgery, Westküstenklinikum Heide, Heide, Germany
Aim: To investigate, via data analysis, the long-term outcome of patients who underwent either laparoscopic or open surgery for Crohn’s disease.
Methods: A total of 113 patients who had undergone first abdominal surgery due to Crohn’s disease between January 2000 and December 2010 in a maximum care provider facility, were included in the statistical analysis. All patients provided their informed consent prior to inclusion. Data were collected from a database. Follow-up data included data from central mortality registries, general practitioners and a specialized clinic. Statistical analysis of the general patient data and the different operations and approaches were performed with the use of chi-square test, Fisher’s exact test, and the Mann–Whitney U test.
Results: The median follow-up period in case of open and laparoscopic surgery was found to be 9 and 6 years, respectively. Statistically significant differences were observed for the following parameters in case of open and laparoscopic surgery, respectively: age (median=44 vs. 36 years, range=15–76 vs. 15–72 years; p=0.007), urgency of operation (23 out of 34 planned vs. 6 out of 70 planned; p<0.001), year of resection (median=2003 vs. 2006, range=2000–2010 vs. 2000–2010; p=0.001). The length of stay in hospital was significantly shorter in the laparoscopic group than that of open surgery group (8 vs. 11 days, respectively; p<0.0001). We did not control for factors such as age and comorbidities in our statistical analysis. We also did not find any differences with regard to perioperative and 90-day mortality, surgical complications, length of specimen, stoma, surgical recurrence rate (10% in both groups) and number of re-admissions. Moreover, we did not find differences between patients with early operation after first symptoms and patients with long course of disease. A statistically significant difference was found for long-term mortality that was higher in the open surgery group than that of laparoscopic group (p=0.005) (the median for open surgery group was significantly higher than that of laparoscopic group).
Conclusion: The outcome of laparoscopic and open surgery is at least comparable. Shorter length of hospital stay and comparable surgical recurrence rates are advantages of laparoscopy.
Keywords: Crohn’s disease, follow-up, retrospective, laparoscopic, open, outcome
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