Impact of Complex Crohn's Disease on the Outcome of Laparoscopic Ileocecal Resection

Goyer, Perrine; Alvès, Arnaud; Brétagnol, F.; Bouhnik, Yoram; Valleur, Patrice; Panís, Yves

doi:10.1007/dcr.0b013e31819c9c08

Cited by 133 publications

(89 citation statements)

References 19 publications

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“…9 In another recent prospective study comparing complicated CD and uncomplicated CD undergoing laparoscopic ICR, a two-stage procedure with a temporary diverting stoma was performed in 39% for complex fistulizing CD (all of them being voluntarily performed). 8 Operative findings evidenced that the inflammatory process in patients who initially had an abscess or phlegmon diminished after 2 weeks of bowel rest. It is therefore likely that our strategy of pre-operative management allowed ICR to be performed with primary anastomosis in circumstances that might have otherwise required a two-stage procedure with diverting stoma.…”

Section: Discussionmentioning

confidence: 99%

“…Abscess, phlegmon or fistulas are not contraindications to a successful laparoscopic ICR. 8,26 Several authors have reported fewer complications associated with the laparoscopic approach. [26][27][28] Nevertheless, the nature of complicated CD can render surgery challenging and the technical difficulties encountered are more pronounced with laparoscopic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 A two-stage procedure including a temporary diverting stoma is often required in up to 39-51% of patients. 8,9 Several risk factors have been associated with a poor outcome of surgery for penetrating CD such as the presence of an abscess at the time of surgery, the use of chronic corticosteroid medication and an impaired nutritional status.…”

Section: Introductionmentioning

confidence: 99%

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Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

Zerbib

Koriche

Truant

et al. 2010

Aliment Pharmacol Ther

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

Zerbib

Koriche

Truant

et al. 2010

Aliment Pharmacol Ther

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“…In many patients a minimally invasive approach is feasible and safe, though has been associated with longer operative times, higher conversion rates, and increased stoma use for complex Crohn's patients including fistula. 17 At the time of surgery, a small probe placed into the external opening will often allow better localization of the tract during the dissection of the bowel. Although I prefer a medial-to-lateral approach in both the open and laparoscopic approaches for lesions in the ileocolic region, the degree of inflammation will be the major determining factor.…”

Section: Spontaneous Ecf In Inflammatory Bowel Disease (Crohn's Disease)mentioning

confidence: 99%

Enterocutaneous Fistula: Medical and Surgical Management Including Patients with Crohn's Disease

Orangio

2010

Clinics in Colon and Rectal Surgery

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Patients with inflammatory bowel disease (IBD) and especially Crohn's disease can be challenging for even the most seasoned of surgeons. Development of an enterocutaneous fistula (ECF) in these patients further adds a level of complexity that requires a well-planned and defined management strategy. The role of the surgeon in caring for these patients should be as the leader of a multidisciplinary team, directing the care of the other specialists, all while determining if, and when, the patient requires operative intervention. Although medical management has come a long way in these and similar patients, surgery is still needed in a vast majority of patients. Therefore, understanding the evaluation, initial management, and important technical considerations for care of IBD and other complex patients with ECFs is a difficult, yet much needed, task for which the surgeon should be prepared. KEYWORDS: Enterocutaneous fistula, inflammatory bowel disease, Crohn's diseaseObjectives: Upon conclusion of this article, the reader should have a thorough understanding of the medical and surgical principles for managing enterocutaneous fistulas (ECFs) including: (1) the importance of a multidisciplinary approach; (2) early management of ECFs; and (3) the unique challenges patients with underlying inflammatory bowel disease provide.Enterocutaneous fistulas (ECFs) are abnormal connections between the gastrointestinal tract and the skin. The majority ( 85%) of ECFs develop following abdominal surgery for intestinal malignancy, inflammatory bowel disease (IBD), recurrent explorations, or after extensive adhesiolysis for conditions such as small bowel obstruction. The remaining 15% form spontaneously secondary to IBD (Crohn's disease >indeterminate colitis >ulcerative colitis), radiation enteritis, diverticular disease, perforated malignancy, intraabdominal sepsis, and abdominal trauma. Although the origin of the ECF can be essentially anywhere along the gastrointestinal (GI) tract, they most commonly arise from small bowel, colon, stomach, and duodenum in decreasing order. 1,2 As spelled out elsewhere in this issue, the management of the ECF requires a multidisciplinary approach, which will often necessitate aggressive medical and surgical management to try to minimize morbidity and mortality. This is especially true in those patients with underlying inflammatory bowel disease, where the potential for a lifetime of disease recurrence and future function must always be considered. Despite the wide range of underlying causes and patient clinical presentations, some basic tenants must be adhered to

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“…Entretanto, as contra-indicações diminuem conforme evoluem a perícia cirúrgica e os equipamentos 6 .…”

Section: Contra-indicaçõesunclassified

Videocirurgia no manejo da doença de Crohn intestinal

Araújo

Dias

Seid

et al. 2010

Rev bras. colo-proctol.

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RESUMO: A doença de Crohn é uma moléstia com um amplo espectro de manifestações. Seu tratamento é complexo e freqüentemente os pacientes portadores desta afecção necessitam de intervenções cirúrgicas. Com o surgimento da laparoscopia e sua popularização no tratamento das afecções intestinais, demonstrando resultados superiores ao acesso convencional e quebrando paradigmas como sua utilização no tratamento do câncer colorretal, passou-se a cogitar se esse acesso seria indicado também nas doenças inflamatórias intestinais. Ainda hoje, a utilização desta via de acesso na doença de Crohn é tema controverso. Devido à natureza inflamatória desta patologia, o grau de dificuldade cirúrgico está aumentado e muitas dúvidas persistem: há benefício para o paciente? A taxa de conversão não está exageradamente aumentada? É possível indicar esse acesso em casos complicados? Qual o grupo de pacientes que se beneficia da técnica? Nesta revisão apresentamos os dados mais recentes e as evidências científicas que sustentam a indicação da via de acesso laparoscópica no tratamento cirúrgico da doença de Crohn. Descritores

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Impact of Complex Crohn's Disease on the Outcome of Laparoscopic Ileocecal Resection

Abstract: This large comparative study suggested that laparoscopic ileocolonic resection for complex Crohn's disease was feasible and safe with good postoperative outcomes. In our experience, complex Crohn's disease does not appear as a contraindication to a laparoscopic approach.

Cited by 133 publications

References 19 publications

Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

Enterocutaneous Fistula: Medical and Surgical Management Including Patients with Crohn's Disease

Videocirurgia no manejo da doença de Crohn intestinal

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