Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management

Pellino, Gianluca; Keller, Deborah S.; Sampietro, Gianluca; Annese, Vito; Carvello, Michele; Celentano, Valerio; Coco, Claudio; Colombo, Francesco; Cracco, N.; Candido, Francesca Di; Franceschi, Marilisa; Laureti, Silvio; Mattioli, Girolamo; Pio, Luca; Sciaudone, Guido; Sica, Giuseppe; Villanacci, Vincenzo; Zinicola, R.; Leone, Salvatore; Danese, Silvio; Spinelli, Antonino; Delaini, Gian Gaetano; Selvaggi, Francesco

doi:10.1007/s10151-019-02145-0

Cited by 31 publications

(17 citation statements)

References 207 publications

(251 reference statements)

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“…Laparoscopy is clearly associated with several short-term benefits in adult and paediatric patients with CD, including shorter time to restoration of bowel function, reduced wound complications and LOS, and better cosmesis [8,9]. SILS represents a further step forward towards minimally invasive surgery in CD [10], but several aspects related to its feasibility remain debated, particularly in view of specific technical challenges posed by CD such as the presence of adhesions and internal fistulae, the thickened vascular mesentery and the subtle nature of some multisite small bowel strictures [11].…”

Section: Discussionmentioning

confidence: 99%

Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn’s disease: a propensity score–matched analysis

Celentano

Pellino

Rottoli

et al. 2020

Int J Colorectal Dis

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Introduction Single-incision laparoscopic surgery (SILS) aims to minimize the surgical access trauma by reducing the number of abdominal incisions to a single site, potentially offering better cosmetic results and decreased postoperative pain. In this study, we compare the results of SILS ileocolic resection for Crohn’s disease (CD) to conventional laparoscopy and open surgery using a propensity score–matched analysis in a retrospective national multicentre study. Methods All consecutive patients undergoing elective SILS ileocaecal or redo ileocolic resection for primary and recurrent CD from 1 June 2018 to 31 May 2019 were included. Patients were matched 1:1:1 with laparoscopy and open surgery according to perianal disease, recurrent disease, penetrating phenotype of CD, history of previous abdominal surgery, preoperative medical treatment with steroids and anti-TNF. Postoperative morbidity within 30 days of surgery was the primary endpoint. Results Fifty-eight patients were included in each group, for a total of 174 patients. The conversion rate for SILS and laparoscopy was 10.3% and 12%, respectively, with no difference in the incidence of postoperative complications (13.8% and 12%, p = 0.77), whilst open surgery demonstrated a worse morbidity profile, with a complication rate of 25.9% (p < 0.0001). Median length of hospital stay following SILS ileocolic resection was 5 days, significantly shorter compared to 7 days for laparoscopy and 9 for open surgery (p < 0.0001). Conclusions SILS ileocolonic resection for CD demonstrated a comparable morbidity profile compared to laparoscopy in selected patients, with a reduced length of postoperative hospital stay.

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Section: Discussionmentioning

confidence: 99%

Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn’s disease: a propensity score–matched analysis

Celentano

Pellino

Rottoli

et al. 2020

Int J Colorectal Dis

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“…Topics and questions were discussed and approved by the steering committee. Individual invitations were sent, and participants were assigned to three working groups: CD; ulcerative colitis; and general principles of management of IBD [7][8][9]. Each collaborator contributed with a specific section; he/she performed the review of the literature, drafted the statements with evidence levels (EL) graded according to "The Oxford Levels of Evidence 2″ of Oxford Centre for Evidence-Based Medicine OCEBM (https ://www.cebm.…”

Section: Methodsmentioning

confidence: 99%

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn’s disease

et al. 2020

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The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a position statement of Italian colorectal surgeons to address the surgical aspects of Crohn's disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of Crohn's disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.

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“…Feasibility and safety of laparoscopic ileo-cecal resection has been assessed and it was found not inferior in terms of outcomes when compared to open surgery [ 53 – 55 ]. Nowadays, laparoscopy is largely accepted as the first line approach for CD, in the presence of adequate expertise [ 56 ]. Laparoscopy demonstrated advantages in terms of cosmetics and postoperative recovery and assured some long-term advantages, including fewer incisional hernias, fewer adhesions and a significant impact on female fertility [ 57 , 58 ]; unfortunately, no clear differences on time to recurrence was found.…”

Section: Surgical Management and CD Recurrencementioning

confidence: 99%

Pathophysiology of Crohn’s disease inflammation and recurrence

et al. 2020

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Chron’s Disease is a chronic inflammatory intestinal disease, first described at the beginning of the last century. The disease is characterized by the alternation of periods of flares and remissions influenced by a complex pathogenesis in which inflammation plays a key role. Crohn’s disease evolution is mediated by a complex alteration of the inflammatory response which is characterized by alterations of the innate immunity of the intestinal mucosa barrier together with a remodeling of the extracellular matrix through the expression of metalloproteins and increased adhesion molecules expression, such as MAcCAM-1. This reshaped microenvironment enhances leucocytes migration in the sites of inflammation, promoting a TH1 response, through the production of cytokines such as IL-12 and TNF-α. IL-12 itself and IL-23 have been targeted for the medical treatment of CD. Giving the limited success of medical therapies, the treatment of the disease is invariably surgical. This review will highlight the role of inflammation in CD and describe the surgical approaches for the prevention of the almost inevitable recurrence.

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Inflammatory bowel disease (IBD) position statement of the Italian Society of Colorectal Surgery (SICCR): general principles of IBD management

Cited by 31 publications

References 207 publications

Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn’s disease: a propensity score–matched analysis

Single-incision laparoscopic surgery (SILS) for the treatment of ileocolonic Crohn’s disease: a propensity score–matched analysis

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn’s disease

Pathophysiology of Crohn’s disease inflammation and recurrence

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