Outcomes of Laparoscopic Versus Open Surgery in the Treatment of Complications of Penetrating Crohn’s Disease: A Systematic Review

Background: Penetrating Crohn’s disease (CD) frequently results in fistulas, abscesses, or strictures, requiring surgery in up to 70% of cases. While laparoscopic surgery (LS) is well established in elective CD, its role in penetrating disease remains uncertain due to technical challenges and variable outcomes compared with open surgery (OS). Methods: We conducted a systematic review following PRISMA guidelines. Comparative studies (retrospective cohorts, propensity-matched analyses, randomized controlled trials, and meta-analyses) were identified through multiple databases. Primary outcomes included perioperative complications, wound infection, incisional hernia, postoperative pain, hospital stay, and disease recurrence. Results: Eight studies were included. LS was associated with reduced perioperative complications (RR 0.71, p = 0.001), lower incisional hernia risk (RR 0.24, p = 0.02), and shorter hospital stay (5 vs. 8 days, p < 0.05). Conversion to OS occurred in 10–25% of cases due to disease extent. Long-term recurrence rates were comparable between LS and OS (30% at 5 years; 60% at 10 years). Conclusion: LS provides superior short-term outcomes over OS in penetrating CD, with fewer complications and faster recovery. Long-term disease control is equivalent, and outcomes depend strongly on patient selection and surgical expertise in managing complex disease.