Risk factors for anastomotic recurrence after primary ileocaecal resection in Crohn’s disease

Aaltonen, Gisele; Keränen, Ilona; Carpelan-Holmström, Monika; Lepistö, Anna

doi:10.1097/meg.0000000000001206

Cited by 14 publications

(9 citation statements)

References 18 publications

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“…Anastomotic margin recurrence has been reported in 34% after primary ileocecal resection. [11] Endoscopic balloon dilatation should be the primary intervention for surgery in experienced centers in strictures and obstructions caused by CD; however, surgical treatment is still in the foreground in most centers. [12,13] The priority of evacuation of abscesses due to CD can be left to percutaneous drainage.…”

Section: Discussionmentioning

confidence: 99%

“…Bleeding and cancer development are less common surgical indications. [3,5,[9][10][11] Obstruction due to stenosis due to chronic recurrent inflammation and fibrosis is one of the most common indications for surgery and the most common surgical procedure is ileocecal resection. This was also consistent with our series since 153 patients (79.7%) underwent ileocecal resection only.…”

Section: Discussionmentioning

confidence: 99%

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Factors affecting the development of complications in Crohn’s disease in patients undergoing intestinal resection

Gures¹,

Uludağ²,

Erginöz³

et al. 2023

Medicine

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Surgery is a common form of management for Crohn disease (CD) in the presence of intra-abdominal complications. In this study, we investigated the effect of various factors on the development of postoperative complications in patients who underwent surgery for complicated CD. Patients who underwent surgery between 2011 and 2018 were included in this study. Information on age, sex, presence of extraintestinal findings, operation indications, operation type, and postoperative complications was obtained. Groups with and without postoperative complications were compared according to body mass index, American Society of Anesthesiologists score, comorbidities, smoking status, preoperative drug use, presence of perianal disease, presence of a stoma, synchronous small intestine resection surgery, duration of hospital stay, and preoperative biochemical parameters. A total of 192 patients were included, of which 53.1% were female and 46.9% were male. Patients were indicated for surgery for reasons such as stricture, abscess, fistula, and tumor development. As the surgical method, patients were operated on by open or laparoscopic method (86% and 14%, respectively). Postoperative complications occurred in 30 female and 33 male patients (15.6% and 17.1%, respectively). Patient age, smoking status, steroid use, perianal disease, presence of stoma, and presence of extra intestinal findings were significantly higher in the complicated group. Surgery may be inevitable for CD in the presence of complications. In cases of patient age, smoking, steroid use, perianal disease, stoma opening, and presence of extra intestinal findings, patients with CD who undergo surgery should be followed up closely in terms of the development of complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors affecting the development of complications in Crohn’s disease in patients undergoing intestinal resection

Gures¹,

Uludağ²,

Erginöz³

et al. 2023

Medicine

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“…Identifying the risk factors associated with postoperative recurrence will markedly benefit patients with CD and will permit doctors to maintain close postoperative surveillance in high-risk cases and optimize CD therapy[ 17 , 18 ]. Although there are conflicting results in the reports according to whether the perforating indication for surgery affects postoperative recurrence[ 19 , 20 ], some studies have indicated that perforating CD is a risk factor for earlier recurrence[ 21 ]. Our results showed that the perforating indication was a predictor of surgical recurrence, which confirmed the concept that the perforating indication for surgery was associated with decreased recurrence-free survival.…”

Section: Discussionmentioning

confidence: 99%

Perforating and nonperforating indications in repeated surgeries for Crohn’s disease

Shen¹,

Huang²,

Liu³

et al. 2022

WJCC

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BACKGROUND Despite advances in medical therapy for Crohn’s disease (CD), most patients with CD require repeated resection surgeries. AIM To analyze the perforating and nonperforating indications of repeated CD operations and identify the anastomosis characteristics for postoperative CD. METHODS We retrospectively reviewed 386 patients who underwent at least one resection for CD between 2003 and 2013.Clinical characteristics of each surgery were collected. Univariate and multivariate analyses were performed to determine risk factors for recurrence. RESULTS The indication for reoperation in CD tends to be the same as that for primary operation, i.e ., perforating disease tends to represent as perforating disease and nonperforating as nonperforating. Concordance was found between the first surgery and second surgery in terms of the indication for the operation ( P = 0.006), and the indication for the third surgery was also correlated with that for the second surgery ( P = 0.033). Even if the correlation of surgical indications between repeated operations, the rate of perforating indication for the second and third surgeries was significantly higher than that of the first surgery. In addition, the presence of perforating CD was a predictor of recurrence for both the first and second surgeries. Moreover, anastomotic lesions were the most common sites of recurrence after the operation. Based on the importance of anastomosis, anastomosis might be a new type of disease location for the classification of postoperative CD. CONCLUSION CD not only has stable characteristics but also progresses chronically. Perforation is a progressive surgical indication for Crohn’s disease. For CD after surgery, anastomosis may be a new classification of disease location.

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“…Gajendran concluded that, according to his data, the restoration of physiologic intestinal function with surgical reconstruction of the bowel as an intact tube could contribute to a better outcome in CD patients. In the same year, Aaltonen’s group [ 75 ] published its series regarding risk factors for anastomotic recurrence. Aaltonen’s et al proposed a technical variant HEEA, adding an opening of the small bowel’s anti-mesenteric border to ensure enough wide bowel lumen, describing this modified technique as a safe choice for ileo-colonic resection.…”

Section: Por: New Discoveries and Trendsmentioning

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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Risk factors for anastomotic recurrence after primary ileocaecal resection in Crohn’s disease

Abstract: Urgent surgery and postoperative corticosteroid need represented risk factors for anastomotic recurrence. Hand-sewn anastomosis with an opening of the bowel's antimesenteric border seems to be a safe choice for ileocaecal resection.

Cited by 14 publications

References 18 publications

Factors affecting the development of complications in Crohn’s disease in patients undergoing intestinal resection

Factors affecting the development of complications in Crohn’s disease in patients undergoing intestinal resection

Perforating and nonperforating indications in repeated surgeries for Crohn’s disease

Pathophysiology of Crohn’s disease inflammation and recurrence

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