Excisional surgery with ileostomy for Crohn's colitis with particular reference to factors affecting recurrence

Steinberg, David M.; Allan, Robert; Thompson, Helen; Brooke, Bryan N.; Alexander-Williams, J; Cooke, W. T.

doi:10.1136/gut.15.11.845

Cited by 67 publications

(24 citation statements)

References 16 publications

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“…Lockhart-Mummery, 1973;Steinberg, et al, 1974). Fourteen patients had disease confined at primary surgery to the small bowel, 43 confined to the large bowel, and 22 had ileocolitis.…”

Section: Resultsmentioning

confidence: 99%

The granuloma in Crohn's disease.

Chambers¹,

Morson²

1979

Gut

120

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“…Lockhart-Mummery, 1973;Steinberg, et al, 1974). Fourteen patients had disease confined at primary surgery to the small bowel, 43 confined to the large bowel, and 22 had ileocolitis.…”

Section: Resultsmentioning

confidence: 99%

The granuloma in Crohn's disease.

Chambers¹,

Morson²

1979

Gut

120

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“…Burman has stated that the recurrence rate was 78 % in patients who had macroscopically diseased bowel at the level of the anastomosis and only a 50% recurrence if the bowel was macroscopically normal. The age of the patient at the time of ileorectal anastomosis has also been shown to influence the recurrence rate; the younger patients having the highest recurrence rate (Stahlgren and Ferguson, 1961;De Dombal et al, 1971;Steinberg et al, 1974). Glass and Baker (1976) have recently stated that the presence or absence of granuloma also has an effect on recurrence.…”

Section: Discussionmentioning

confidence: 99%

Ileorectal anastomosis in patients with Crohn's disease of the colon.

Flint¹,

Strauss²,

Platt³

et al. 1977

Gut

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SUMMARY Thirty-seven patients were studied who had an ileorectal anastomosis performed for Crohn's disease of the colon. Twenty-nine were done as a primary procedure and in eight the anastomosis was made after previous total or segmental colectomy. Three There has been much discussion and controversy concerning the practicality of performing an ileorectal anastomosis after colectomy for Crohn's colitis. The surgeon may choose to leave the rectum in situ either because he considers the patient to be a poor surgical risk or because the rectum appears to be normal or near normal at the time of surgery. Total colectomy with ileostomy and mucous fistula is the most frequently performed operation for extensive Crohn's colitis, but it is our contention that either a primary ileorectal anastomosis or an ileorectal anastomosis after a total colectomy and ileostomy is a preferable procedure in selected cases.The purpose of this study was to analyze our results in a group of 37 patients with Crohn's disease of the colon who were treated by colectomy and ileorectal anastomosis so as to have a basis for comparison with the results obtained with colectomy

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“…Of 2017 unique studies identified using our search strategy, 17 studies met our inclusion criteria. 10,11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] In addition, we identified one abstracts from conference proceedings 31 and hence, included a total of 18 studies for quantitative synthesis. Figure 1 shows the schematic diagram of study selection.…”

Section: Resultsmentioning

confidence: 99%

“…some patients were operated before availability of anti-TNF agents in 1998 and others after 1998). Among the eight studies that explicitly reported definition of clinical recurrence, 10,17,23,25,27,28,30,31 two did not 17,31 required confirmation of disease activity (through endoscopy and/or imaging) in patients with new onset gastrointestinal symptoms. Six studies were performed in North America 11,16,19,23,24,30 and 12 in Europe.…”

Section: Resultsmentioning

confidence: 99%

Systematic review with meta‐analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy

Fuméry

Dulai

Meirick

et al. 2016

Aliment Pharmacol Ther

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Background Subtotal or total colectomy or proctocolectomy with permanent ileostomy (TC-PI) may be a treatment option for medically refractory colonic Crohn's disease (CD). Aim To perform a systematic review and meta-analysis to evaluate the rate, risk factors and outcomes of CD recurrence after TC-PI. Methods In a systematic review ending March 31, 2016, we identified 18 cohort studies (1438 adults) who underwent TC-PI for colonic CD (median follow-up, 7.4 years; interquartile range, 5.3-9.0). We estimated pooled rates (with 95% confidence interval [CI]) of clinical and surgical recurrence, and risk factors for disease recurrence. Results On meta-analysis, the risk of clinical recurrence after TC-PI was 28.0% (95% CI, 21.7-35.3; 14 studies, 260/1004 patients), with a 5- and 10-year median cumulative rate of 23.5% (range, 7-35) and 40% (range, 11-60), respectively. The risk of surgical recurrence was 16.0% (95% CI, 11.1-22.7; 10 studies; 183/1092 patients), with a 5- and 10-year median cumulative rate of 10% (range, 3-29) and 18.5% (range, 14-34), respectively. The risk of clinical and surgical recurrence in patients without ileal disease at baseline was 11.5% (95% CI, 7.7-16.8) and 10.4% (95% CI, 4.5-22.5), respectively. History of ileal disease was associated with 3.2 times higher risk of disease recurrence (RR, 3.2; 95% CI, 1.8-5.6). Other inconsistent risk factors for disease recurrence were penetrating disease and young age at disease onset. Conclusions Small bowel clinical recurrence occurs in about 28% of patients after TC-PI for colonic CD. Disease recurrence risk is 3.2 times higher in patients with history of ileal disease, and continued medical therapy may be advisable in this population. In patients without ileal inflammation at surgery, continued endoscopic surveillance may identify asymptomatic disease recurrence to guide therapy.

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Excisional surgery with ileostomy for Crohn's colitis with particular reference to factors affecting recurrence

Cited by 67 publications

References 16 publications

The granuloma in Crohn's disease.

The granuloma in Crohn's disease.

Ileorectal anastomosis in patients with Crohn's disease of the colon.

Systematic review with meta‐analysis: recurrence of Crohn's disease after total colectomy with permanent ileostomy

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