剖腹手术
医学
腹腔镜检查
肠系膜
外科
普通外科
作者
Diane Mège,Fabrizio Michelassi
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2020-02-01
卷期号:271 (2): 317-324
被引量:19
标识
DOI:10.1097/sla.0000000000002995
摘要
Objective: To identify preoperative characteristics to help in selecting laparoscopy or laparotomy in Crohn disease (CD). Summary Background: Laparoscopy in CD is associated with high rates of conversion. Methods: All patients undergoing abdominal surgery for CD in 2004 to 2016 by the senior author. Patients operated by laparoscopy, laparotomy, and converted to open were compared. Results: Four hundred fifty-eight procedures were performed in 427 patients [F:M 1:1; median age = 41 (12–95) yrs], through laparotomy (n = 157, 34%) or laparoscopy (n = 301, 66%). Laparotomy rates decreased over time. Concomitant surgical procedures requiring laparotomy continued to dictate an open approach throughout the study. Sixty-five cases (21.6%) required conversion to laparotomy which occurred within 15’ from start of case in 77%. Most common reasons for conversion included dense adhesions (34%), pelvic sepsis with fistulizing disease (26%), large inflammatory mass (18%), and thickened mesentery (9%). After multivariate analysis, predictive factors for conversion included recurrent disease after previous small bowel resection, thickened mesentery, large inflammatory mass, and extensive disease. Conclusion: Despite the increasing experience with laparoscopy in CD, one-fifth of selected cases still need conversion. Recurrent disease with dense adhesions, pelvic sepsis with fistulizing disease, large inflammatory mass, and thickened mesentery are all conditions predisposing to a conversion. When the severity of these conditions is known preoperatively or a simultaneous procedure requires a laparotomy, an open approach should be considered; if laparoscopy is selected, conversion to laparotomy can be decided early in the performance of the case.
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