Minimally Invasive Surgery in Complex Crohn's Disease

Sapcı, İpek; Görgün, Emre

doi:10.1055/s-0039-1683922

Cited by 10 publications

(5 citation statements)

References 36 publications

(45 reference statements)

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“…Tan et al showed in their meta-analysis that there was no statistical difference between laparoscopic and open surgery for small-bowel CD and that the recent ECCO guidelines support a first laparoscopic surgery as a first-line approach in patients with CD with a surgical indication. 11,15,16 A laparoscopic approach reduces postoperative complications and reduces the negative impact of surgery in patients with CD by limiting scars. However, with minimally invasive surgeries, it may be difficult to precisely assess the extension of CD because palpation of the affected segment is not possible.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn’s Disease

Bihain

Caron

Ayav

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: The European Crohn’s and Colitis Organization guidelines have highlighted the importance of the preoperative evaluation of the affected segment length in patients with ileocolic Crohn's disease to determine the best surgical approach. OBJECTIVE: This study aimed to evaluate the accuracy of preoperative magnetic resonance enterography in assessing the length of the affected segment in patients with ileocolic Crohn’s disease. DESIGN: This observational study was conducted with a prospectively maintained database and retrospective analysis. SETTINGS: This study was conducted in a tertiary center. PATIENTS: This study included consecutive patients undergoing ileocolic resection for Crohn’s disease between August 2014 and June 2020. All patients underwent a preoperative magnetic resonance enterography. MAIN OUTCOME MEASURES: The correlation between the length measured on magnetic resonance enterography and pathological examination was evaluated. RESULTS: A total of 96 patients were included. The median time between magnetic resonance enterography and surgery was 65.5 (3–331) days. The length of the affected segment on magnetic resonance enterography was correlated with the length assessed on pathological evaluation (R = 0.48, p < 0.001). No correlation was found between the 2 measurements when imaging was performed >6 months before surgery (R = 0.14, p = 0.62). The presence of an abscess underestimated the length affected by Crohn’s disease on imaging compared to pathology, whereas the presence of a fistula was associated with magnetic resonance enterography overestimation of the length of the affected segment. LIMITATIONS: Limitations included single-center study and retrospective analysis. CONCLUSION: In Crohn’s disease, preoperative magnetic resonance enterography is a highly reliable tool for predicting the length of the affected segment compared to pathology examination in the absence of an abscess or fistula. See Video Abstract at http://links.lww.com/DCR/C26. ENTEROGRAFÍA POR RESONANCIA MAGNÉTICA PREOPERATORIA PARA PREDECIR LA LONGITUD DE MUESTRAS PATOLÓGICAS EN LA ENFERMEDAD DE CROHN ANTECEDENTES: Las guías de la Organización Europea de Crohn y Colitis han resaltado la importancia de la evaluación preoperatoria de la longitud del segmento afectado para determinar el mejor abordaje quirúrgico. OBJETIVO: Evaluamos la precisión de la enterografía por resonancia magnética preoperatoria para evaluar la longitud del segmento afectado en pacientes con enfermedad de Crohn ileocólica. DISEÑO: Realizamos un estudio observacional con una base de datos mantenida prospectivamente y un análisis retrospectivo. CONFIGURACIÓN: Este estudio se realizó en un centro terciario. PACIENTES: Se incluyeron pacientes consecutivos sometidos a resección ileocólica por enfermedad de Crohn entre Agosto de 2014 y Junio de 2020. A todos los pacientes se les realizó una enterografía por resonancia magnética preoperatoria. PRINCIPALES MEDIDAS DE RESULTADO: Se evaluó la correlación entre la longitud medida en la enterografía por resonancia magnética y el examen patológico. RESULTADOS: Se incluyeron un total de 96 pacientes. El tiempo mediano entre la enterografía por resonancia magnética y la cirugía fue de 65,5 (3–331) días. La longitud del segmento afectado en la enterografía por resonancia magnética se correlacionó con la longitud evaluada en la evaluación patológica (R = 0,48, p < 0,001). No hubo correlación entre las 2 mediciones cuando las imágenes se realizaron más de 6 meses antes de la cirugía (R = 0,14, p = 0,62). La presencia de un absceso subestimó la longitud afectada por la enfermedad de Crohn en las imágenes en comparación con la patología, mientras que la presencia de una fístula se asoció con una sobrestimación de la longitud del segmento afectado por enterografía por resonancia magnética. LIMITACIONES: Las limitaciones incluyeron un estudio de un solo centro y un análisis retrospectivo. CONCLUSIÓNES: En la enfermedad de Crohn, la enterografía por resonancia magnética preoperatoria es una herramienta altamente confiable para predecir la longitud del segmento afectado en comparación con el examen de patología, en ausencia de absceso o fístula. Consulte el Video Resumen en http://links.lww.com/DCR/C26. (Traducción—Dr. Yesenia Rojas-Khalil)

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Section: Discussionmentioning

confidence: 99%

Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn’s Disease

Bihain

Caron

Ayav

et al. 2022

Diseases of the Colon &Amp; Rectum

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“…Two case-matched comparison studies of robotic versus laparoscopic proctectomy for IBD patients presented similar complication rates, short-term functional results, conversion rate, and length of stay for both groups, but the robotic group had a longer operative time [42,43]. Robot- assisted surgery can have advantages in pelvic nerve preservation during proctectomy, but further research is warranted as surgeons adapt to robotic surgery for IBDs [44].…”

Section: Inflammatory Bowel Diseasementioning

confidence: 95%

Robot-Assisted Colorectal Surgery

Kim¹

2022

Ewha Med J

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Minimally invasive surgery for colorectal disease has now become the standard treatment in Republic of Korea. However, there are limitations to the laparoscopic approach, such as an unstable camera support, a limited range of motion, and poor ergonomics. Recent advances in technology have led to the introduction of robotic surgical systems in colorectal surgery to overcome these shortcomings. Robot-assisted colorectal surgery has clear advantages in many aspects. Surgery involving the rectum benefits the most among colorectal diseases owing to technical difficulties in rectum dissection. The concept of robotic surgery is not different from laparoscopic surgery in that it is a minimally invasive surgery, and abundant research demonstrates comparable results from both modalities for postoperative complications, oncological outcomes, and functional outcomes. However, the cost of robot-assisted surgery limits surgeons to performing robotic surgeries in only selected cases. Improvements regarding cost-effectiveness and more convincing studies that support benefits of robotic surgery are needed to popularize robot-assisted colorectal surgery.

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“…techniques are associated with overall improvement in outcomes. 8,9 These benefits are associated with equivalent or fewer perioperative complications including fewer re-operations for obstruction. [8][9][10][11][12][13] However, until recently, there has been a paucity of data regarding MIS for complex and reoperative Crohn's disease.…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Management of Complicated and Re-operative Crohn's Disease

Kinford,

Poylin

2024

Clin Colon Rectal Surg

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Minimally invasive techniques for the surgical management of Crohn's disease have become the recommended approach for initial surgical intervention in noncomplicated patients as there is lower morbidity for patients without compromising treatment outcomes. There has been a push to expand minimally invasive approaches to complex and recurrent diseases, trying to benefit these difficult patients. However, until recently there have been little data to support the adoption of minimally invasive surgery (MIS) in these scenarios. This article aims to build on the 2019 Clinics in Colon and Rectal Surgery article on complex Crohn's and MIS by introducing new data in support of these approaches. Decisions for technique should be based on patient characteristics, but minimally invasive techniques have emerged as valid and possibly superior for complex and recurrent disease.

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Minimally Invasive Surgery in Complex Crohn's Disease

Cited by 10 publications

References 36 publications

Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn’s Disease

Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn’s Disease

Robot-Assisted Colorectal Surgery

Minimally Invasive Management of Complicated and Re-operative Crohn's Disease

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