Ileocecal resection for primary Crohn's disease: a 17-year experience from a tertiary care hospital in North Africa.

Abstract

Introduction: Ileocecal resection (ICR) is the most common procedure for primary Crohn's disease. While outcomes of ICR have been extensively studied in Europe and North America, data from North Africa remains scarce. This study reports a 17-year Tunisian experience, evaluating the feasibility of laparoscopic ICR in a low-income country in comparison to open surgery.

Methods: This retrospective, single-center study reviewed patients who underwent ICR for histologically confirmed Crohn's disease between 2004 and 2020. Postoperative outcomes of laparoscopic and open approaches were compared. The endpoint was postoperative morbidity and mortality, intraoperative parameters, and recovery metrics.

Results: A total of 336 patients underwent surgery for non-recurrent ileocecal Crohn's disease, with laparoscopic resection performed in 80% of cases. Conversion to open surgery occurred in 14.9%, mainly due to hemorrhagic dissection. Postoperative complications occurred in 9.2% of patients, with anastomotic leakage being the most frequent surgical issue. Medical complications were rare (1.2%). Laparoscopy was associated with faster recovery, shorter hospital stays, and lower analgesic requirements, although complication rates were not significantly different. The only significant predictor of anastomotic fistula was low body mass index (BMI) (P < .001). Postoperative mortality was 0.5%.

Conclusion: In low-income countries, including North Africa, access to laparoscopy has expanded, with outcomes such as conversion rates and operative times approaching international standards. In our 17-year Tunisian experience, laparoscopic ICR proved feasible, reproducible, and safe. These findings contribute to the limited regional evidence and support the broader adoption of laparoscopy as the preferred surgical approach for Crohn's disease.