Long-term outcome of laparoscopic ileocecal resection for Crohn's disease before the era of biologics.

Background: Crohn's disease (CD) of the terminal ileum not responding to standard medical treatment is more and more treated with biologics instead of surgery. In order to get more information on the results of surgery, we analyzed the outcome of laparoscopic ileocecal resection (LICR) performed before the widespread use of these drugs.

Methods: Chart reviews and telephone follow-ups were performed on 119 patients treated with laparoscopic ileocecal resection for CD. Follow-ups were performed at a median of 58 (17-124) and 113(69-164) months. Symptomatic restenosis requiring surgery or endoscopic dilatation was the primary endpoint. We further analyzed risk factors of recurrence.

Results: Of the 119 patients initially treated, 18 required surgery (n = 14) or endoscopic dilatation (n = 4). The calculated rates of re-intervention were 10 und 17.5 % at 5 and 10 years, respectively. Ninety percent of the patients had a Crohn-specific medication treatment at the time of surgery, but only 51.4 und 46.9 % at FU 1 und 2, respectively. Smoking increased the risk of recurrence (OR 3.7, P = 0.011).

Conclusion: The data demonstrate excellent long-term results of LICR for CD of the terminal ileum. Surgery should be considered as a first choice treatment in many patients with ileocecal CD not responding to conventional treatment.