Minimally invasive surgery in Crohn's disease: state-of-the-art review

Abstract

Surgery for Crohn's disease (CD) has undergone significant advancements over the last two decades, especially minimally invasive surgery. In addition to its feasibility and safety, minimally invasive surgery provides manifold advantages, including a decreased hospitalization duration, improved aesthetic results, and fewer occurrences of intra-abdominal adhesions. Due to the special intraoperative characteristics of CD, such as chronic inflammation, a thickened mesentery, fistulas, abscesses and large masses, a minimally invasive approach seems to be challenging. Complete implementation of this technique for complex disease has yet to be studied. In this review, we provide a review on the applicability of minimally invasive surgery in CD and future perspectives for the technical advances in the field.

Keywords: complex; complication; laparoscopic surgery; laparoscopy; robotic surgery; surgery; transanal surgery.

Figure 1

(1-A) search for correct tissue layer; (1-B,1-C) Use an aspirator to open adhesions (2-A). Identify the appendix; (2-B). Perform appendix-directed anatomic dissection; (2-C). Ensuring complete dissection of the ileocecal region (40).

Figure 2

Strictureplasty by handsewm and endoscopic GIA. (1-A) Handsewm H-M strictureplasty; (1-B) Stapled H-M strictureplasty; (2-A) Handsewm Finney strictureplasty; (2-B) Stapled Finney strictureplasty; (3-A,3-B) Handsewm Michelassi stricturoplasty; (4-A,4-B) Stapled Michelassi stricturoplasty (44).

Figure 3

Photographs of the creation of a laparoscopic intracorporeal stapled anastomosis excluding mesentary. (A) Divided the mesentery of ileum; (B) Transected terminal ileum 2 cm proximal to the diseased bowel, placing the Endo GIA perpendicular to the the mesentery which is located in the middle of the staple lines; (C) Transected the colon in a similar manner; (D) Sewn two stapled lines together; (E) Created an antimesenteric small enterotomy on each stump, 6 cm away from the staple line; (F) Fashioned a side-to-side anastomosis with a Endo GIA using one 60 mm-long cartridge; (G) Closed the enterotomy; (H) Closed the mesenteric defect; (I) Morphology of stapled anastomosis excluding mesentary.