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Laparoscopic redo surgery in recurrent ileocolic Crohn's disease: A standardised technique

 Department of Colorectal Surgery, Portsmouth Hospitals NHS Trust; Faculty of Science, University of Portsmouth, Portsmouth, England, United Kingdom

Correspondence Address:
Valerio Celentano,
Portsmouth Hospitals NHS Trust; University of Portsmouth, Portsmouth, England
United Kingdom
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmas.JMAS_144_18

PMID: 30178767

Background: Despite many advances in the medical management of Crohn's disease (CD), there is still a significant risk of surgical resection for lack of response to medical management or complications during the lifetime of a patient. Laparoscopic surgery offers short-term benefits such as decreased pain, lower wound complication rates, earlier resumption of diet and bowel function, better cosmesis and shorter hospital stays, while reduced post-operative adhesions and lower incisional hernia rate may represent long-term benefits. Methods: A modular, standardised laparoscopic approach can be applied to safely perform laparoscopic redo surgery in the hostile setting of the recurrent CD and to facilitate teaching and training of these advanced procedures. Results: Laparoscopic surgery in CD can be particularly challenging due to multifocal disease with extensive inflammation and a thickened mesentery, the potential for abscesses, fistulas and phlegmons and high conversion rates have been reported in reoperative surgery for recurrent CD with abscesses and adhesions representing the main reasons for conversion. Conclusions: A standardised laparoscopic approach for redo surgery in recurrent CD has been described. Multidisciplinary management of CD is essential and bowel preservation must be the priority.

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2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04