Reduced-port laparoscopic ileocecal resection with intracorporeal isoperistaltic anastomosis for Crohn's disease: a single-center comparative study
David Julià-Bergkvist, Nuria Gomez-Romeu, Olga Delisau, Eloi Maldonado, Maria Jose Gomez-Jurado, Anna Pigem, Pere Planellas, David Busquets, Judith Luquin, Paula Creus, Frank Fernandez, David Sambrano, Marc Fonollosa, Bernat Montane, Lara Coll, Claudia Vila, Lluis Agostini, Ramon FarresAbstract
Introduction
Whether three-port laparoscopic ileocecal resection with intracorporeal isoperistaltic anastomosis provides outcomes comparable to conventional non-reduced port surgery in elective Crohn's disease remains unclear.
Methods
This retrospective per-protocol study included patients undergoing elective ICR for L1 or L2 Crohn's disease between 2016 and 2025. Patients were divided into reduced-port and non-reduced port groups. Baseline characteristics were comparable. In the reduced-port group, a three-port technique with two operating ports and one camera port was used, and resection with intracorporeal isoperistaltic anastomosis was completed laparoscopically (video). Specimen was extracted through an enlargement of the umbilical incision, less comonly a Pfannenstiel incision. The non-reduced port group underwent predominantly four-port approach, with either intracorporeal or extracorporeal anastomosis according to surgeon preference. Outcomes included anastomotic leakage, conversion, clinical recurrence (CDAI >200 at 6–12 months), and endoscopic recurrence at 6 months(Rutgeerts ≥i2b).Fisher's exact test was used.
Results
70 patients were included, of whom 38 (54%) underwent reduced-port surgery. Anastomotic leakage occurred in 2/38 patients (5.3%) in the reduced-port group and 3/32 patients (9.4%) in the non-reduced port group (P = 0.65).6 conversions to open surgery occurred in the non-reduced port group. Four Kono-S in the non-reduced port group. Clinical recurrence was similar (15.8 versus 15.6%, P = 1.0).Endoscopic recurrence at 6 months occurred in 8/37 patients (21.6%) in the reduced-port group and 3/30 patients (10.0%) in the non-reduced port group (P = 0.32).
Discussion
Three-port laparoscopic ileocecal resection with intracorporeal isoperistaltic anastomosis appears safe and achieves outcomes comparable to non-reduced port surgery in elective Crohn's disease. This approach reduces the number of abdominal incisions and may improve cosmetic outcomes without compromising clinical or endoscopic results.