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Time to recovery of gastrointestinal function is less with a laparoscopic ileoanal procedure but lengths of hospital stays are only slightly diminished [31] buy generic kamagra super 160 mg line. Operative times for the laparoscopic approach are longer and upfront costs are higher buy cheap kamagra super 160 mg line. On the other hand, complication rates, long-term functional results, and quality of life with lap- aroscopic surgery are at least equivalent and may be superior to the open procedure [32]. Some of the clear benefits of laparoscopic ileoanal procedure include better cosmesis and a lower risk for incisional hernias [33]. Additionally because laparo- scopic surgery in general is known to produce fewer intraabdominal adhesions, it is believed that the laparoscopic approach may lessen the long-term risk for adhe- sive postoperative bowel obstructions, although the necessary long-term follow-up data to support this theory is yet to be reported. Currently, there is also no available data on whether the laparoscopic approach would have an effect on the risk for infertility in women undergoing the ileoanal procedure. Effect of resection margins on the recurrence of Crohn’s disease in the small bowel. An international, multicenter, prospective, observa- tional study of the side-to-side isoperistaltic strictureplasty in Crohn’s disease. Management of gastrointestinal bleeding after strictureplasty for Crohn’s disease. Conservative surgical management of terminal ileitis: side-to-side enterocolic anastomosis. Metaanalysis of trials comparing laparoscopic and open surgery for Crohn’s disease. Does a laparoscopic approach to total abdominal colectomy and proctocolectomy offer advantages?

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Strictureplasty is also contraindi- cated in the presence of peritoneal sepsis and peritonitis cheap kamagra super 160 mg on line. With all these considerations approximately 15% of patients undergoing surgical treatment for small bowel Crohn’s disease are appropriate candidates for one or more of the strictureplasty techniques cheap kamagra super 160 mg fast delivery. Potential Complications Unlike resections where diseased tissue is removed to grossly normal margins and anastomotic suture are placed in healthy tissues, sutre lines of strictur- oplasties are typically placed within scarred and diseased tissue. Fortunately, with expe- rience, perioperative morbidity with strictureplasty has proven to be low [6]. The most common complication directly attributed to stricturoplasties is intraluminal suture line hemorrhage at the site of the strictureplasty and suture line dehis- cence. Some degree of suture line hemorrhage occurs in up to 9% of cases with half of these resulting in the need for transfusions in excess of three units [7]. Bleeding severe enough to require reoperation is however very uncommon and occurs in less than 1% of the cases. Poor healing with suture line leakage is a more serious, but less frequent complication and occurs in 1–2% of stricture- plasty cases. When a suture line dehiscence occurs at a strictureplasty, open lapa- rotomy with resection of the strictureplasty and establishment of a temporary ileostomy is often required. Because the diseased tissue remains after strictureplasty, the possibility of pro- gression of this disease has been a concern.

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