6 Laparoscopic_COCORULLO.qxp_-

Surgery finds in Crohn’s disease a main role in the management of obstructive or septic complications. Of course, to reserve it as the last treatment to use whenever medical therapy alone is insufficient, results in performing an intervention on more serious patients with more surgical complications (1-3). Through the years, granulomatous enteritis can develop a scar thickening with tight stenosis and a progressive obstructive course which finally requires a planned surgical intervention. Elective surgical treatments are proposed in patients with sub-occlusive presentation due to strictures, chronic fistulas or with high CD index (>220) with a terminal ileum-cecum disease (4). Among the complications of the disease acute intestinal obstruction is the most frequent; the 35-54% of these cases involving the terminal ileum that is moreover the most frequent tract involved by the disease; digiunal (22-36%) or colonic disease (5-17%) can cause an occlusive framework, too (5). Firstly medical therapy is anyway attempted in the management of acute obstructions if peritonitis or fever does not income (4). The resection of the terminal ileum and cecum is the most widespread intervention in these cases and it is performed both for acute disease non responder to medical therapy and for advanced disease. Right hemicolectomies or more extensive resections are often not needed while harmful, so these are not recommended (1, 4). Minimally invasive laparoscopic treatments find today an important role in the treatment of CD. SUMMARY: Laparoscopic ileocecal resection in acute and chronic presentations of Crohn’s disease. A single center experience.