Place de la laparoscopie dans la prise en charge de la maladie de Crohn compliquée

In primary Crohn's disease (CD), laparoscopic ileocolic resection has been shown to be safe and feasible and is associated with improved outcomes such as postoperative morbidity and length of hospital stay. It is today unclear whether laparoscopic surgery can be safely proposed on a regular basis for patients with complex CD such as localized abscess, fistula or recurrent disease. The aim of this systematic review was to assess the feasibility and safety of laparoscopic surgery for complex our recurrent CD. In the current literature, there are nine non-randomized cohort studies of which two were case-matched. The mean conversion rate reported in these series ranged from 7 to 42%. Morbidity rate and hospital stay following laparoscopic resection for complex CD were similar to those for primary resection or for non-complex CD. In summary, even if strong evidence is lacking and more contributions with larger size are needed, the limited experiences available from the literature confirm that laparoscopic approach for complex CD in hands of IBD surgeons with a deep expertise in laparoscopic surgery is feasible and safe. Further studies are required to confirm these results and determine precisely selection criteria of the patients.