Laparoscopic Surgery for Different Diseases related to Gastroenterology

Gastroenterology diseases like Crohn disease remains a challenging clinical entity, both medically and surgically. It frequently presents in early adulthood and imposes a lifetime exposure to chronic inflammation that can affect the entire gastrointestinal tract. 

Approximately 70 to 90% of the patients with Crohn disease will ultimately require surgery. There is no definitive cure for Crohn disease and surgery is reserved for failed medical therapy or the complications of the disease, namely, obstruction, septic complications and fistulas.

In fact, laparoscopic surgery offers many advantages, which are particularly beneficial to this subset of patients, such as fewer wound complications, a shortened hospital course, less tissue trauma and subsequent adhesion formation, and earlier resumption of oral intake and bowel function.  

Ileocolic inflammation is the most common pattern of disease in Crohn disease. Laparoscopic surgery for small bowel Crohn disease is safe and feasible but did not impart a definitive advantage over open surgery. Specifically, there are no statistical significant differences in rates of wound infection, pneumonia, urinary tract infection, anastomotic leak, intra-abdominal abscess, duration of hospital stays, or reoperation for disease recurrence.

Hand-assisted laparoscopic surgery (HALS) has gained considerable acceptance as a practical alternative to traditional laparoscopic surgery, HALS results in similar clinical outcomes as compared with standard laparoscopy. HALS provides tactile feedback and the ability for adequate retraction that may be beneficial in this subset of patients due to the inflammation, thickened mesentery, the potential for abscesses and fistulas, and bulky specimens that may not be appropriate for standard laparoscopy.

Single-Incision Laparoscopic Surgery has become increasingly used in a variety of colorectal procedures, including inflammatory bowel disease. Hence, Laparoscopy offers excellent short- and long-term outcomes like conventional open surgery. Although operative times are generally longer in a laparoscopic approach, there are well-established benefits in improved cosmesis, quicker return of bowel function, and shorter hospital stay. Laparoscopy is also possible in recurrent disease and confers similar benefits to primary resections.

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