Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Gutiérrez, Ana; Rivero, Montserrat; Martín-Arranz, María Dolores; Sánchez, V. García; Castro, Manuel; Barrio, Jesús; Francisco, Ruth de; Acosta, Manuel Barreiro‐de; Juliá, Berta; Cea‐Calvo, Luis; Romero, Cristina; Borruel, Natalia; Domènech, Eugeni

doi:10.1093/gastro/goz010

Cited by 18 publications

(21 citation statements)

References 39 publications

(37 reference statements)

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“…Another factor that has been largely associated with increased complication rates is surgery in an urgent setting [23], which occurred in 31% of the cases in our study. Complications were indeed more frequent in this group, underscoring the importance of these surgeries being performed in specialized centers in order to minimize morbimortality [24, 25].…”

Section: Discussion/conclusionmentioning

confidence: 83%

Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

et al. 2020

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Introduction: Abdominal surgery in patients with Crohn’s disease (CD) is challenging, especially in the biologic era. The aim of this study was to evaluate factors associated with increased risk for postoperative complications in CD. Methods: A retrospective study was conducted with consecutive patients who underwent abdominal surgery for CD from January 2012 to January 2018. Results: Of 103 patients, 32% had postoperative complications. Gender, age, disease location and phenotype, hemoglobin and albumin levels, previous abdominal surgery, and preoperative optimization did not differ between the groups with or without complications. Thirty-five percent of the patients were under anti-TNF therapy, and this medication was not associated with increased risk for postoperative complications. Time since the onset of the disease was significantly higher in patients with complications (12.9 vs. 9.4, p = 0.04). In multivariate analysis, creation of ostomy and urgent surgery were the only variables independently associated with increased risk for complications (OR 3.2, 95% CI 1.12–9.46 and OR 2.94, 95% CI 0.98–9.09, respectively). Conclusion: Urgent surgery for CD should preferably be performed in specialized centers, and creation of stoma is not necessarily associated with lower rate of postoperative complications but rather less severe complications.

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Section: Discussion/conclusionmentioning

confidence: 83%

Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

et al. 2020

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“…Strictureplasty is another conservative surgical technique that preserves bowel length and in the most comprehensive systematic review to date, has demonstrated a 30% reoperation rate and 13% complication rate for jejunoileal strictureplasty procedures, with 59% of the patients having surprisingly undergone previous bowel surgery[ 37 ]. The most invasive method to remove a CD induced refractory obstruction is surgical resection, with two separate reviews identifying a 29% risk of a second intestinal resection and a 28% early complication rate[ 38 , 39 ]. Evidently, surgery may result in an elevated risk of postoperative complications and short bowel syndrome, potentially leading to increased morbidity, mortality and a decreased quality of life[ 8 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Crohn’s strictures open with anti-mycobacterial antibiotic therapy: A retrospective review

Collyer¹,

Clancy²,

Agrawal³

et al. 2020

WJGE

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BACKGROUND Medical therapy for strictures is limited and first-line treatment consists of endoscopic balloon dilatation, strictureplasty or surgical resection. Mycobacterium tuberculosis , Helicobacter pylori and Streptococcus can all cause stenosis, for which antibiotic treatment achieves stricture resolution. Mycobacterium avium ssp. paratuberculosis is a suspected causative agent in Crohn’s disease (CD). Thus, specialized antimicrobial treatment, in particular, anti-mycobacterial antibiotic therapy (AMAT) has been proposed as a potential treatment option. To our knowledge, the opening of CD strictures has not been recorded using any form of antibiotic therapy. We hypothesized that AMAT would resolve strictures in patients with CD. AIM To investigate the effect and outcomes of AMAT in a cohort of CD patients with an ileal stricture. METHODS A single center, retrospective, medical record case review was conducted on an observational cohort of patients with CD who had an ileal stricture on colonoscopy and were treated with AMAT. Forty patients meeting the inclusion criteria were identified from the internal medical database. Thirty (75%) patients had follow-up colonoscopy and clinical data available. The AMAT regimen was prescribed after the initial colonoscopy for a duration of at least six months until follow-up colonoscopy with the attending gastroenterologist. Patient demographics, symptoms, colonoscopy reports, inflammatory serum markers and concurrent medications were recorded at pre-treatment and follow-up between January 1995 and June 2018. RESULTS Of the patients that returned for follow-up after > 24 mo of AMAT, twenty (67%) had complete resolution (CR) of their ileal strictures, three (10%) had partial resolution and seven (23%) had no resolution. Irrespective of stricture outcome, 21 patients (70%) demonstrated clinical response to AMAT and there was a statistically significant reduction in inflammatory serum markers C-reactive protein ( P < 0.0001) and erythrocyte sedimentation rate ( P = 0.04) from pre-treatment to follow-up. It was observed that 11 (37%) patients experienced side effects, but no serious adverse effects were attributable to AMAT. At follow-up there were 26 (87%) patients on concomitant medication for CD and a statistically significant association between CR and AMAT with a concomitant immunomodulator ( P = 0.02). CONCLUSION This study demonstrated a high rate of stricture resolution (67%) similar to that seen in tuberculosis strictures (70%), suggesting a shared mycobacterial origin of strictures, and perhaps disease.

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“…A recent study shows that wound infection, intra-abdominal abscess, and anastomotic leak are the most common complications after intestinal resection with ileocolonic anastomosis in Crohn's disease, about 24.2% of all patients [ 29 ]. In our study, the complication rate of 26.4% seems high, even after PSH.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Surgical Home Model Improves Outcomes in Crohn’s Disease Patients Undergoing Disease-Related Surgery

Yao

Huang

et al. 2020

Gastroenterology Research and Practice

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Background. To evaluate Perioperative Surgical Home (PSH) practice model implementation in Crohn’s disease (CD) patients undergoing disease-related surgery. Methods. A retrospective analysis of CD patients requiring disease-related surgery in the Shanghai Ninth People’s Hospital was undertaken. Subjects were divided into a non-PSH group consisting of 49 patients (June 2016 to November 2017) and a PSH group consisting of 72 patients (December 2017 until May 2019). Conventional treatment was used for the non-PSH group, while in the PSH group, a standardized pre- and postoperative management routine was employed. The postoperative lengths of stay and incidences of postoperative complications were analyzed. Results. There were no significant differences in demographics, reasons for surgery, preoperative BMIs, and preoperative hemoglobin between the two groups (P>0.05). The overall incidence of complications in the PSH group was dramatically lower than that in the non-PSH group (26.4% vs. 44.9%, P=0.035). In the PSH group, postoperative length of stay was significantly shorter than that in the non-PSH group (11.5±5.7 vs. 9.0±6.8, P<0.001). Conclusions. The PSH conditioning routine in CD patients undergoing disease-related surgeries suggests a trend of fewer postoperative complications and shorter lengths of hospital stay. The PSH model may have clinical advantages when applied to CD patients.

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Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Cited by 18 publications

References 39 publications

Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

Crohn’s strictures open with anti-mycobacterial antibiotic therapy: A retrospective review

Perioperative Surgical Home Model Improves Outcomes in Crohn’s Disease Patients Undergoing Disease-Related Surgery

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