Current Status of Laparoscopic Surgery for Crohn's Disease

Abstract

Laparoscopic surgery has been clinically accepted for stricturing ileocecal Crohn's disease without fistula, abscess or large inflammatory mass. With the recent advancement of laparoscopic devices, this approach has been further modified to "single port surgery", which has an apparent cosmetic advantage over conventional laparoscopic surgery. Laparoscopic surgery, however, remains technically challenging for complicated cases and/or recurrent disease, resulting in a higher rate of open conversion. The surgical approach should be carefully determined for these cases, with full consideration of mini-laparotomy assistance and/or hand-assisted laparoscopic surgery (HALS). Currently, HALS is our preferred method especially for cases requiring total/subtotal colectomy for diffuse colonic disease expecting retrieval of a bulky specimen. The true advantage of these "minimally invasive" surgical approaches over conventional open surgery remains unclear, and so further studies, ideally prospective randomized trials, are necessary.