Laparoscopic or Open Surgery for Inflammatory Bowel Disease

Although most patients with inflammatory bowel diseases may ideally be treated with laparoscopic surgery, challenges include inflammation and fragility of the bowel wall and the mesentery, difficulty identifying normal anatomic landmarks, and coexisting abscesses and fistulas. In addition, these diseases commonly require extensive resections while operating within limited spaces. In this article, we present current data regarding the techniques, advantages, and outcomes of laparoscopy for patients with inflammatory bowel diseases. Common indications for minimally invasive surgery are Crohn's disease of the terminal ileum, colectomy, total proctocolectomy, and stoma formation in patients with severe perianal disease. The literature supports laparoscopic bowel resection because of shorter time to first bowel movement, shorter hospitalization, and less morbidity compared with laparotomy. Laparoscopy can even be used with low morbidity in patients who have undergone surgery and/or who have abscesses and fistulas. The most common standard elective operations for ulcerative colitis are total abdominal colectomy with ileostomy and restorative proctocolectomy. Laparoscopy is preferentially used in these situations by experienced surgeons in major centers. Although the minimally invasive approaches to Crohn's disease and ulcerative colitis are associated with some complications and contraindications, numerous studies have proven the efficacy, feasibility, and safety of these procedures for appropriately selected patients when undertaken by properly qualified surgeons.