Microscopic Inflammation at Ileocaecal Resection Margins in Crohn’s Disease: Prevent Recurrence or Treat Residual Disease?

2019 ◽  
Vol 14 (6) ◽  
pp. 872-873
Author(s):  
Paulo Gustavo Kotze ◽  
Takayuki Yamamoto
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Residual Disease ◽  
Resection Margins ◽  
Microscopic Inflammation

scholarly journals The Influence of Microscopic Inflammation at Resection Margins on Early Postoperative Endoscopic Recurrence After Ileocaecal Resection for Crohn’s Disease

2019 ◽  
Vol 14 (3) ◽  
pp. 361-368 ◽  
Author(s):  
Karolina Poredska ◽  
Lumir Kunovsky ◽  
Filip Marek ◽  
Zdenek Kala ◽  
Vladimir Prochazka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Duration ◽  
Resection Margins ◽  
Endoscopic Recurrence ◽  
Histological Results ◽  
Resected Bowel ◽  
Microscopic Inflammation

Abstract Background and Aims The pathogenesis and risk factors for early postoperative endoscopic recurrence of Crohn’s disease [CD] remain unclear. Thus, this study aimed to identify whether histological inflammation at the resection margins after an ileocaecal resection influences endoscopic recurrence. Methods We have prospectively followed up patients with CD who underwent ileocaecal resection at our hospital between January 2012 and January 2018. The specimens were histologically analysed for inflammation at both of the resection margins [ileal and colonic]. We evaluated whether histological results of the resection margins are correlated with endoscopic recurrence of CD based on colonoscopy 6 months after ileocaecal resection. Second, we assessed the influence of known risk factors and preoperative therapy on endoscopic recurrence of CD. Results A total of 107 patients were included in our study. Six months after ileocaecal resection, 23 patients [21.5%] had an endoscopic recurrence of CD. The histological signs of CD at the resection margins were associated with a higher endoscopic recurrence [56.5% versus 4.8%, p < 0.001]. Disease duration from diagnosis to surgery [p = 0.006] and the length of the resected bowel [p = 0.019] were significantly longer in patients with endoscopic recurrence. Smoking was also proved to be a risk factor for endoscopic recurrence [p = 0.028]. Conclusions Histological inflammation at the resection margins was significantly associated with a higher risk of early postoperative endoscopic recurrence after an ileocaecal resection for CD.

scholarly journals Microscopic inflammation in ileocecal specimen does not correspond to a higher anastomotic leakage rate after ileocecal resection in Crohn’s disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247796
Author(s):  
Christian Schineis ◽  
Andrea Ullrich ◽  
Kai S. Lehmann ◽  
Christoph Holmer ◽  
Johannes C. Lauscher ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Anastomotic Leakage ◽  
Resection Margin ◽  
Frozen Section ◽  
Leakage Rate ◽  
Ileocecal Resection ◽  
Resection Margins ◽  
Anastomotic Leakage Rate ◽  
Microscopic Inflammation

Background Patients with Crohn’s disease suffer from a higher rate of anastomotic leakages after ileocecal resection than patients without Crohn’s disease. Our hypothesis was that microscopic inflammation at the resection margins of ileocecal resections in Crohn’s disease increases the rate of anastomotic leakages. Patients and methods In a retrospective cohort study, 130 patients with Crohn’s disease that underwent ileocecal resection between 2015 and 2019, were analyzed. Anastomotic leakage was the primary outcome parameter. Inflammation at the resection margin was characterized as “inflammation at proximal resection margin”, “inflammation at distal resection margin” or “inflammation at both ends”. Results 46 patients (35.4%) showed microscopic inflammation at the resection margins. 17 patients (13.1%) developed anastomotic leakage. No difference in the rate of anastomotic leakages was found for proximally affected resection margins (no anastomotic leakage vs. anastomotic leakage: 20.3 vs. 35.3%, p = 0.17), distally affected resection margins (2.7 vs. 5.9%, p = 0.47) or inflammation at both ends (9.7 vs. 11.8%, p = 0.80). No effect on the anastomotic leakage rate was found for preoperative hemoglobin concentration (no anastomotic leakage vs. anastomotic leakage: 12.3 vs. 13.5 g/dl, p = 0.26), perioperative immunosuppressive medication (62.8 vs. 52.9%, p = 0.30), BMI (21.8 vs. 22.4 m2/kg, p = 0.82), emergency operation (21.2 vs. 11.8%, p = 0.29), laparoscopic vs. open procedure (p = 0.58), diverting ileostomy (31.9 vs. 57.1%, p = 0.35) or the level of surgical training (staff surgeon: 80.5 vs. 76.5%, p = 0.45). Conclusion Microscopic inflammation at the resection margins after ileocecal resection in Crohn’s disease is common. Histologically inflamed resection margins do not appear to affect the rate of anastomotic leakages. Our data suggest that there is no need for extensive resections or frozen section to achieve microscopically inflammation-free resection margins.

On-table endoscopy to define strictures and resection margins: experience from 178 operations for Crohn's disease using intraoperative endoscopy

2001 ◽  
Vol 3 (Supplement 2) ◽  
pp. 58-62
Author(s):  
G. Olaison ◽  
P. Andersson ◽  
P. Myrelid ◽  
K. Smedh ◽  
J. Soderholm ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Resection Margins ◽  
Intraoperative Endoscopy

1068 The Presence of Microscopic Disease at the Resection Margins Predicts Post-Surgical Relapse in Crohn's Disease

2012 ◽  
Vol 142 (5) ◽  
pp. S-189-S-190 ◽  
Author(s):  
James Kinchen ◽  
Kowsala Rajaratnam ◽  
Gearoid Kingston ◽  
Anthony S. Mee ◽  
Aminda N. De Silva
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Resection Margins

scholarly journals Localization of recurrent lesions ileocolic resection for Crohn's disease

2020 ◽  
Author(s):  
Hiroki Ikeuchi ◽  
Motoi Uchino ◽  
Toshihiro Bando ◽  
Yuki Horio ◽  
Ryuichi Kuwahara ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Bowel Resection ◽  
Residual Disease ◽  
Causative Factor ◽  
Anastomotic Site ◽  
Ileocolic Resection ◽  
Initial Surgery

Abstract Background Crohn’s disease (CD) recurrence can occur not only at the site of anastomosis but also elsewhere in the bowel following ileocolic resection (ICR). The aims of the present study were to assess long-term outcomes of a primary ICR procedure for CD in consecutive patients and examine the location of the reoperation causative lesion. Methods We examined cases of surgery with ICR initially performed at our institution. Those with a simultaneous multiple bowel resection or bowel resection with strictureplasty were excluded. Results A total of 169 patients who underwent ICR due to CD were enrolled. The median follow-up period was 12.6 years (range 4–27 years). A reoperation was needed in 45 (26.6%), of whom 14 had lesions causative of the reoperation at other than the anastomotic site. The most common causative lesion location was in the colon rather than the oral side of the small intestine. Furthermore, we investigated the relationship between presence of residual lesions following the initial surgery and lesions causative of reoperation. In the group without residual disease (n = 31), 29.0% (n = 9) had non-anastomotic lesions involved in indications for reoperation, while that was 35.7% (n = 5) in the group with residual disease (n = 14). Conclusions Anastomotic site lesion is not the only causative factor for reoperation following ICR. Regular examinations and applicable treatment with awareness that the cause of reoperation is not limited to the site of anastomosis are important in these cases.

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