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3.2 Surgical techniques in stricturing Crohn’s disease (CD)

Due to the incurable nature of CD and the alleviation of symptoms as the principle of treatment, the concept of surgical treatment of CD has been evolved from massive ablation of diseased area to minimally invasive surgery that reserves as much intestinal tract as possible. Surgeons have gradually abandoned the outdated concept that surgery on CD is difficult due to mesenteric hypertrophy, tissue fragility and abdominal adhesion, and continuously tried laparoscopic surgery on CD (10). Hand-assisted laparoscopy, single site laparoscopy, and robot-assisted surgery on treating CD have also been reported in recent years (11-13). The advantages of using laparoscopic surgery on CD are evident, with the same ones like pleasing appearance, small incision, and fast-recovery (14). Some patients with postoperative recurrence can still choose laparoscopic surgery (15). Bergamaschi et al. (16) compared 39 patients who underwent laparoscopic ileocolic resection with 53 patients who had open ileocolic resection, and found out that five-year small-bowel obstruction rates were 11.1 and 35.4%, respectively, in laparoscopic ileocolic resection and open ileocolic resection patients, and the difference was statistically significant. Nevertheless, the rate of switching to open abdomen surgery during laparoscopic surgery remains high. The key of prevention is strict screening of patients who are suitable for the procedure. In this study, the rate of laparoscopic surgery was low and that of switching to open abdomen surgery during laparoscopic surgery was high. This is mainly due to the fact that the author’s team did not have either a complete understanding of laparoscopic surgery on inflammatory bowel disease, or an adequate pre-surgery evaluation. In some patients with postoperative recurrence, the abdominal adhesion was less severe than pre-surgery evaluation, and they can still choose laparoscopic surgery.

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3.2 Surgical techniques in stricturing Crohn’s disease (CD)

Due to the incurable nature of CD and the alleviation of symptoms being the aim of treatment, the concept of surgical treatment for CD has evolved from massive ablation of the diseased area to minimally invasive surgery that reserves as much of the intestinal tract as possible. Surgeons have gradually abandoned the outdated concept that surgery for CD is difficult due to mesenteric hypertrophy, tissue fragility, and abdominal adhesion and have continuously attempted performing laparoscopic surgery for CD (10). The use of hand-assisted laparoscopy, single site laparoscopy, and robot-assisted surgery for treating CD has also been reported in recent years (11-13). The advantages of using laparoscopic surgery for CD are evident, and it also has benefits of pleasing appearance, small incision, and fast recovery (14). Some patients with postoperative recurrence can still choose to undergo laparoscopic surgery (15). Bergamaschi et al. (16) compared 39 patients who had undergone laparoscopic ileocolic resection with 53 patients who had undergone open ileocolic resection and found that five-year small bowel obstruction rates were 11.1 and 35.4% in patients who had undergone laparoscopic ileocolic resection and those who had undergone open ileocolic resection, respectively. This difference was statistically significant. Nevertheless, the rate of switching to open abdominal surgery during laparoscopic surgery remains high. The key to prevent this is the strict screening of patients who are suitable to undergo the procedure. In this study, the rate of laparoscopic surgery was low and that of switching to open abdominal surgery during laparoscopic surgery was high. This is mainly due to the fact that the author’s team did not have a complete understanding of laparoscopic surgery for inflammatory bowel disease or perform an adequate preoperative assessment. In some patients with postoperative recurrence, abdominal adhesion was less severe than that suggested by preoperative assessment, and the patients were able to choose laparoscopic surgery.