Risikofaktoren für einen frühen OP-Zeitpunkt und chirurgische Komplikationen bei Morbus Crohn

Kühn, Florian; Nixdorf, Maximilian; Schwandner, Frank; Klar, E.

doi:10.1055/a-0645-1489

Cited by 7 publications

(4 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The chronic nature of CD is the reason a vast number of patients have many risk factors for perioperative complications. According to several studies [ 10 – 14 ], age, preoperative weight loss, malnutrition, low albumin level, elevated C-reactive protein (CRP) level, disease duration, penetrating behavior, duration of surgery, open surgery, previous resection, and use of steroids or anti-TNF medications are associated with an increased risk of complications. However, rates of complications vary widely (17.6% to 40.9%) in different studies [ 10 – 13 ], and the safety of preoperative anti-TNF therapy is still debated.…”

Section: Introductionmentioning

confidence: 99%

Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland

et al. 2021

View full text Add to dashboard Cite

Background In Crohn disease (CD), pharmacotherapy with nutritional support is the treatment of choice. However, complications and a lack of response to drugs are indications for surgery. The aim of this study was to present indications for surgery and methods of surgical treatment of CD and to analyze the postoperative morbidity and mortality risk factors. Material/Methods This was a retrospective analysis of adult patients who underwent surgery for CD between January 2015 and January 2019. Sixty of 457 patients (13%) hospitalized for CD required surgical treatment. The parameters age, sex, body mass index, duration, behavior and location of the disease, pharmacotherapy, indications for surgery, type and duration of surgery, perioperative complications, and laboratory tests results were analyzed. Results Most procedures (90%) were elective. The most common indications for surgery were fistulae and strictures. The most frequently performed procedure was right hemicolectomy (60%). Thirty-two percent of patients had postoperative complications. Perianal disease ( P =0.002) and penetrating behavior ( P =0.01) were associated with more surgeries. Stricturing and penetrating behavior was more frequent in patients with ileal/ileocecal involvement than in those with CD affecting the colon ( P =0.039). Patients with smoking history had a significantly lower age at first surgery ( P =0.02). The use of anti-TNF medications appeared to extend time between diagnosis and first surgery ( P =0.014). Conclusions Although the analysis did not reveal any risk factors for perioperative complications, perianal manifestations, penetrating disease type, ileal/ileocecal involvement, and smoking may be associated with risk of earlier surgery or multiple surgeries.

show abstract

Section: Introductionmentioning

confidence: 99%

Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Taking >20 mg of prednisolone over a period of more than 2 weeks is associated with an increased complication rate of surgical therapy in IBD [11,39]. Guidelines on UC suggest tapering of the glucocorticoid dose preoperatively, assuming this is clinically feasible [11].…”

Section: Perioperative Medication and Complicationsmentioning

confidence: 99%

Impact of Modern Drug Therapy on Surgery: Ulcerative Colitis

Kuehn

Hodin

2018

Visc Med

View full text Add to dashboard Cite

Background: The primary treatment of ulcerative colitis (UC) is conservative, and substantial therapeutic progress has been made in the past few decades. Meanwhile, biologicals have become a mainstay in the treatment for steroid-refractory UC. Despite further development of drug therapy and an increased time span to operation, a significant proportion of patients with UC require surgical intervention. Surgical intervention needs to be carried out in medically refractory cases, imminent or malignant transformation, or complications. This article discusses the impact of modern drug therapy on surgery for UC. Methods: A selective literature search of PubMed was conducted, taking into account current studies, reviews, meta-analyses, and guidelines. Selected articles were then reviewed in detail and recommendations were drafted based on data and conclusions of the articles. Results: In recent years, modern drug therapy has changed the timing, approach, and outcomes of surgery for UC. Most of the studies showed a decrease in surgery rates over time while the rate of emergency colectomies remains unchanged. So far, no convincing surgery-sparing effect of newer medications has been established, and it remains debatable if surgery rates have decreased because of improved management for UC in general or due to the introduction of biologicals. The intensified conservative therapy with increasing use of biologics has been accompanied by a trend towards performing a three-step procedure in the last decade. There is a subset of patients with complex refractory disease who most likely benefit from elective surgery as an alternative to prolonged conservative therapies after failure of first-line treatment. The majority of patients after ileal pouch-anal anastomosis can avoid hospitalizations and colitis-related medications with their associated potential adverse effects. In addition, the procedure substantially reduces UC-related symptoms and the risk for dysplasia or cancer. There is a long-term pouch success rate of >90% after 10 and 20 years of follow-up. Conclusion: Conservative medical therapy in the treatment of UC will continue to develop and the number of approved therapeutics will grow. Surgery should not be considered as the negative endpoint of treatment modalities but as a good alternative to a prolonged conservative therapy for some patients. In conclusion, a close cooperation between the various disciplines in the pre- and postoperative management is essential in order to optimize the timing and outcome of patients with UC.

show abstract

“…Die zunehmende Spezialisierung und Zentrenbildung in der Medizin hat dazu geführt, dass die Proktologie als "Querschnittsfach" im klinischen Alltag immer wichtiger wirddies gilt nicht nur für die Viszeralchirurgie, sondern in gleicher Weise für Gastroenterologie, Urologie, Gynäkologie, Dermatologie, Pädiatrie und Geriatrie. So ist die Proktologie bei interdisziplinären Kooperationen wie Beckenbodenzentren oder CED-Zentren unentbehrlich [1] dies gilt in besonderem Maße für die gemeinsame Zertifizierung für Chirurgische Koloproktologie der Deutschen Gesellschaft für Allgemein-und Viszeralchirurgie (DGAV) und der Deutschen Gesellschaft für Koloproktologie (DGK). Darüber hinaus trifft für die Proktologie zu, dass "Bewährtes und Neues", "Standards und Innovationen" und das Zusammenspiel von konservativen und chirurgischen Therapieoptionen im Mittelpunkt dieses Faches stehen.…”

unclassified

Editorial

Schwandner¹,

Schiedeck²

2019

Zentralbl Chir

View full text Add to dashboard Cite

Risikofaktoren für einen frühen OP-Zeitpunkt und chirurgische Komplikationen bei Morbus Crohn

Cited by 7 publications

References 22 publications

Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland

Retrospective Study of Surgical Outcomes in 60 Patients with Crohn Disease from a Single Center in Poland

Impact of Modern Drug Therapy on Surgery: Ulcerative Colitis

Editorial

Contact Info

Product

Resources

About