Laparoscopic Approach

As we will explain in another chapter, the use of the laparoscopic approach in CD surgery seems to be very convenient, both for its minor surgical impact and for reduction in hospitalisation time. After laparoscopic techniques spread and technical skill increased, surgeons could not only create diverting ileostomies but also ileal or ileocolic resections. In the literature, results of the laparoscopic approach is controversial, but it seems to reduce hospitalisation, morbility, and the need for analgesics, as pointed out in a recent study regarding open versus laparoscopic resections [28]. However, we must report the experience of Kehlet the pioneer of "fast-track surgery". In a recent work [29], he reported excellent results in 29 consecutive patients operated for CD. Using a multimodal approach (peridural anaesthesia, early mobilisation, alimentation), the average postoperative hospitalisation was 3 days and complications were extremely low. In the light of this experience, we must once more emphasise the importance of appropriate and intensive management of the patient during the perioperative stage.

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