Laparoscopic management of Crohn's disease

Abstract

The application of minimally invasive surgical (MIS) techniques in the pediatric population has greatly expanded since the 1990s. Several advanced procedures such as laparoscopic splenectomy, fundoplication, and colon pull-through have become commonplace and in fact, in many centers, is the technique of choice. One area that has lagged behind is the MIS treatment of isolated or limited intestinal strictures associated with Crohns disease, requiring segmental resection with anastomosis (Becmeur and Besson 1998; Hamel et al. 2001; Milsom et al. 2001). These procedures involve several obstacles not encountered in other MIS operations, the greatest of which is creating a patent and watertight anastomosis. The procedure can be broken down into three steps, mobilization, resection, and anastomosis. In a limited number of cases a stricturoplasty may be sufficient. Each of these steps provides unique challenges, and the length of intestine involved and the size of the patient may dictate the type of procedure performed. However recent advances in instrumentation and technique have made each of these situations approachable and perhaps preferable to standard open techniques. © Springer-Verlag Berlin Heidelberg 2008.