scholarly journals P215 The effect of resection margin involvement of Crohn’s disease on the surgical and clinical recurrence after intestinal surgery

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S249-S249
Author(s):  
J H Seo ◽  
J L Lee
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Confidence Interval ◽  
Resection Margin ◽  
Intestinal Surgery ◽  
Repeat Surgery ◽  
Clinical Recurrence ◽  
Margin Involvement ◽  
Surgical Recurrence ◽  
Increased Risk

Abstract Background Approximately 80% of patients with Crohn’s disease (CD) require major intestinal surgery during their lifetime and a quarter of patients will undergo repeat surgery within 5 years of the index surgery. For this reason, operative treatment of CD has been the bowel-sparing approach for several decades. This study evaluated the effects of the Crohn’s disease involvement of resection margin on clinical and surgical recurrence. Methods This retrospective study analysed 803 patient who underwent intestinal surgery for CD between January 2006 and December 2015. The CD involvement of resection margin was defined as microscopic involvement from the pathologic reports and grossly involvement from the operative records. Anastomosis recurrence was reviewed using the operative records and radiologic findings including colonoscopy, computed tomography and magnetic resonance imaging. Results In total, 41 patients (5.1%) had an active CD in the bowel resection margin – 31 patients (3.9%) with histologically, 10 patients (1.2%) with grossly. We had 221 (26.8%) reoperation cases, of which 87 (10.6%) patients were an anastomotic recurrence. When patients were stratified by surgical recurrence at anastomosis, the increased risk was not significant in resection margin positive grossly (odds ratio [OR], 3.65; 95% confidence interval [CI], 0.93–14.41) and in microscopic (OR, 1.26; 95% CI, 0.43–3.70) comparing with negative resection margin. Also, resection margin involvement was not related with clinical recurrence grossly (OR, 0.30; 95% confidence interval [CI], 0.07–1.26) and in microscopic (OR, 0.50; 95% CI, 0.21–1.17) Conclusion The current practice suggests the CD involvement of resection margin, even grossly or microscopic, do not influence surgical and clinical recurrence.

scholarly journals Ex vivo model for a new bilateral antimesenteric V-modified side-to-side isoperistaltic anastomosis to prevent recurrence in ileocolic Crohn’s disease

2019 ◽  
Vol 101 (5) ◽  
pp. 313-317 ◽  
Author(s):  
V Celentano ◽  
F Luvisetto ◽  
S Toh
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Ex Vivo ◽  
High Rate ◽  
Ex Vivo Model ◽  
Repeat Surgery ◽  
Handsewn Anastomosis ◽  
Surgical Recurrence ◽  
Mesenteric Border

Introduction The high rate of recurrence following ileocaecal resection for Crohn’s disease may lead to repeat surgery in 20–30% of patients at five years after surgery. Recurrence usually occurs at the anastomosis and the neoterminal ileum and the association of a strictureplasty to widen the bowel lumen in the regions immediately proximal (‘anastomotic inlet’) and distal (‘anastomotic outlet’) to the anastomosis may delay or reduce the risk of surgical recurrence. Materials and methods A side to side isoperistaltic anastomosis, with an associated V-modified strictureplasty on the anti-mesenteric border at the level of the anastomosis inlet and outlet has been designed. We produced a wet lab ex vivo model of the anastomosis and, to evaluate the different calibre of the anastomotic segments, we compared it with ex vivo models of three anastomotic configurations currently used in surgery for Crohn’s disease: i) side to side isoperistaltic anastomosis; ii) modified side-to-side isoperistaltic anastomosis with double Heineke–Mikulicz procedure (Sasaki anastomosis); iii) anti-mesenteric functional end-to-end handsewn anastomosis (Kono-S anastomosis). Results Differences were recorded at the level of the anastomosis inlet and outlet, with a larger volume estimated in the Sasaki anastomosis and in the V-modified anastomosis. The V-modified anastomosis had a larger volume compared with the Sasaki anastomosis for a longer segment of small bowel. Conclusions We have developed an experimental animal model for a new anastomotic technique which could be applied in surgery for Crohn’s disease following small-bowel or ileocolic resection.

scholarly journals Management and outcomes of patients with Crohn’s disease with first vs multiple surgeries: results from the PRACTICROHN study

2019 ◽  
Author(s):  
Marisa Iborra ◽  
Berta Juliá ◽  
Maria Dolores Martín Arranz ◽  
Manuel Barreiro-de Acosta ◽  
Ana Gutiérrez ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Prophylactic Treatment ◽  
Operative Management ◽  
Clinical Recurrence ◽  
Free Survival ◽  
Surgical Recurrence ◽  
Ileocolonic Anastomosis ◽  
Baseline Characteristics ◽  
First Time

Abstract Background Surgery in Crohn’s disease (CD) may be associated with poor prognosis and clinical and surgical recurrence. The aim of this study was to describe and compare the post-operative management and outcomes of patients with CD who underwent first vs recurrent surgeries. Methods Observational study that included adult CD patients from 26 Spanish hospitals who underwent ileocolonic resection with ileocolonic anastomosis between January 2007 and December 2010. Data were retrospectively collected from the medical records. Results Data from 314 patients were analysed, of whom 262 (83%) underwent first surgery and 52 (17%) referred to previous CD surgeries. Baseline characteristics were similar between the two groups except for a higher rate of stricturing behavior at diagnosis among re-operated patients (P = 0.03). After surgery, a higher proportion of re-operated patients received prophylactic treatment with immunomodulators compared with patients with first surgery (P = 0.04). In re-operated patients, time to clinical recurrence was not associated with the fact of receiving or not prophylaxis, whereas, in patients with first surgery, recurrence-free survival was greater when prophylaxis was received (P = 0.03). Conclusions After surgery, a higher proportion of patients with previous surgeries received prophylactic treatment with immunomodulators compared with patients with first surgery. Although prophylactic treatment was beneficial for preventing clinical recurrence in patients operated on for the first time, it did not significantly reduce the risk of further recurrence in patients with previous surgeries. This suggests that effective prophylactic therapies are still needed in this subset of patients.

Myenteric plexitis at the proximal resection margin is a predictive marker for surgical recurrence of ileocaecal Crohn's disease

2015 ◽  
Vol 17 (4) ◽  
pp. 304-310 ◽  
Author(s):  
H. Misteli ◽  
C. E. Koh ◽  
L. M. Wang ◽  
N. J. Mortensen ◽  
B. George ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Resection Margin ◽  
Predictive Marker ◽  
Surgical Recurrence ◽  
Proximal Resection Margin

scholarly journals The Risk Factors of Surgical Recurrence in Patients With Crohn's Disease After First Intestinal Surgery

2011 ◽  
Vol 140 (5) ◽  
pp. S-281
Author(s):  
Hyun Jin Jo ◽  
Kyu Joo Park ◽  
Mi Na Kim ◽  
Jong Pil Im ◽  
Sang Gyun Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Surgery ◽  
Surgical Recurrence

scholarly journals OP18 Surgical prevention of anastomotic recurrence by excluding mesentery in Crohn’s disease: The SuPREMe-CD study

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S015-S016
Author(s):  
G Luglio ◽  
A Rispo ◽  
N Imperatore ◽  
A Amendola ◽  
F P Tropeano ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Recurrence Rate ◽  
Conventional Group ◽  
Control Group ◽  
Clinical Recurrence ◽  
Endoscopic Recurrence ◽  
Surgical Recurrence ◽  
Randomised Controlled ◽  
Rutgeerts Score

Abstract Background Recently, a new antimesenteric, functional end-to-end, hand-sewn ileocolic anastomosis (Kono-S) has shown a significant reduction in endoscopic recurrence score and surgical recurrence rate in Crohn’s disease (CD).This trial aimed to provide randomised controlled data comparing Kono-S anastomosis and stapled ileocolic side-to-side anastomosis. Methods Randomised controlled trial at a tertiary referral institution, enrolling and randomising to undergo either the ‘Kono group’ or the ‘Conventional group’, all CD subjects needing surgery. Primary endpoint: endoscopic recurrence (ER) (Rutgeerts score ≥i2) after 6 months. Secondary endpoints: clinical recurrence (CR) after 12 and 24 months, ER after 18 months and surgical recurrence (SR) after 24 months. Also, short-term outcomes and postoperative complications were recorded. A sample size of 70 patients (35 in each group) was considered necessary to demonstrate a reduction >30% in endoscopic recurrence at 6 months follow-up in the Kono group when assuming a 60% endoscopic recurrence expected rate in the control group. Results 79 CD patients were enrolled and randomised in the Kono group (36) or Conventional group (43) (Table 1). After 6 months, 22.2% in the Kono group and 62.8% in the Conventional group presented an ER (p < 0.001; OR 5.91). A severe postoperative ER (Rutgeerts score ≥i3) was found in 13.8% of Kono vs. 34.8% of Conventional group (p = 0.03; OR 3.32). CR rate was 8% in the Kono group vs. 18% in the Conventional group after 12 months (p = 0.2) and 18% vs. 30.2% after 24 months (p = 0.04, OR 3.47). SR rate after 24 months was 0% in the Kono group vs. 4.6% in the Conventional group (p = 0.3). Patients with Kono-S anastomosis presented a longer time until CR than patients with side-to-side anastomosis (HR 0.36, p = 0.037). On binary logistic regression analysis, the Kono-S anastomosis was the only variable significantly associated with a reduced risk of ER (OR 0.19, p < 0.001). About postoperative outcomes, there were no differences between Kono and Conventional groups in terms of surgery duration (p = 0.8), days to gas (p = 0.4) or stool canalisation (p = 0.8) and postoperative stay (p = 0.3). Infections (included wound infection) were found in 4 subjects in the Kono group (13.7%) vs. 6 patients (16.6%) in the Conventional group (p = 0.749). Conclusion This is the first RCT comparing Kono-S anastomosis vs. standard anastomosis in CD, which found a significant reduction of postoperative endoscopic recurrence rate by using the novel technique, without concerns about safety. The Kono-S anastomosis could be considered the new recommended surgical technique in CD. ClinicalTrial.gov NCT02631967.

scholarly journals P493 Segmental colectomy vs. extended colectomy for colonic Crohn’s disease: results from 112 consecutive patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S431-S432
Author(s):  
A Frontali ◽  
A Chierici ◽  
X Treton ◽  
L Maggiori ◽  
Y Bouhnik ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Postoperative Morbidity ◽  
Clinical Recurrence ◽  
Surgical Recurrence ◽  
Age At Surgery ◽  
Significant Difference ◽  
Segmental Colectomy ◽  
Comparative Results

Abstract Background According to recent literature, extended colectomy (EC) and segmental colectomy (SC) are equally effective for colonic Crohn’s disease (CCD), with no differences in terms of postoperative morbidity, incidence of long-term recurrence and definitive stoma, but earlier recurrence is observed in patients with SC. Our objective was to evaluate our comparative results between EC and SC. Methods All consecutive patients undergoing surgery for CCD (EC vs. SC) in our Centre were included and compared and we evaluated postoperative morbidity, long-term clinical and surgical recurrence. Results One hundred and twelve patients (mean age at diagnosis of CD, 31 ± 17 years, mean age at surgery 42 ± 17 years) with CCD underwent EC (n = 45) or SC (n = 67); 62 (55%) patients presenting concomitant small bowel disease, 10 (9%) an extra-intestinal manifestation and 16 (14%) were active smokers. Postoperative morbidity was 8/45 (18%) in case of EC vs. 9/67 (13%) in case of SC (NS). In EC group, 8/8 (100%) complicated patients vs. 16/37 (43%) uncomplicated patients were under anti-TNF before surgery (p = 0.04). This significant difference was not showed in SC group. After a median follow-up of 40 ± 34 months (range 1–130), clinical recurrence incidence was 15/45 (33%) in EC vs. 27/67 (40%) in SC patients (NS) and surgical recurrence was 8/45 (18%) in CE vs. 13/67 (19%) in CS patients (NS). Recurrence of the disease occurred after 19 ± 20 months (range, 1–74) in EC vs. 14 ± 26 months (range, 1–130) in CS patients (p = NS). Conclusion Our study confirms that in case of surgery for CCD, EC and SC are equally safe and feasible but recurrence happens earlier after SC than EC. Additionally, the role of anti-TNF is confirmed for postoperative complications.

scholarly journals P644 Post-operative Crohn’s disease recurrence in Glasgow: How common is it and does deprivation matter?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S533-S533
Author(s):  
E Brownson ◽  
S Shields ◽  
M H Derakhshan ◽  
J Macdonald ◽  
G Nicholson ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biochemical Recurrence ◽  
Male Gender ◽  
Age At Diagnosis ◽  
Recurrence Rates ◽  
Clinical Recurrence ◽  
Endoscopic Recurrence ◽  
Surgical Recurrence ◽  
Younger Age

Abstract Background 50% of patients with Crohn’s disease (CD) will have surgery within the first 10 years, with 35% requiring additional surgery in the following decade. The REMIND cohort-linked male gender, smoking and previous resection to recurrence1. The link between CD and deprivation is debated, while its influence on recurrence is unknown. We aimed to define our local post-operative CD population, highlighting recurrence rates and associated risk factors. Methods CD resections between 2008 and 2014 were identified from NHS Greater Glasgow and Clyde Pathology Archive. Data including gender, age at diagnosis/resection, Montreal classification and smoking status was obtained from the Electronic Patient Record (EPR). Scottish Index of Multiple Deprivation (SIMD) score was determined by postcode and was ranked 1–5 (most to least deprived). Five years of follow-up data were collected. The type of recurrence was recorded as clinical recurrence - symptom flare requiring a course of steroids or inpatient admission; biochemical recurrence—faecal calprotectin >250 µg/l; endoscopic recurrence; or surgical recurrence—the need for further Crohn’s disease-related surgery. Results 304 patients (59.5% female) were included. Median age at diagnosis was 29 (range 3–82 years) and at resection was 43 (range 17–85 years). 52.9% of patients were never-smokers, 16.5% were ex-smokers and 30.6% were current smokers. 33.6% of patients had a SIMD score of 1. Eighty-two per cent had ileal, colonic or ileocolonic involvement. 46.7% of patients had clinical recurrence, 48.7% biochemical recurrence and 31.6% endoscopic recurrence. 15.8% required further surgery for CD. For clinical recurrence, younger age at diagnosis (p = 0.012, and younger age at resection (p = 0.002) were significant determinants. Gender, smoking and SIMD were not significantly associated with recurrence. Chemical recurrence showed similar associations. Similarly, for surgical recurrence, younger age at diagnosis (p = 0.030, and younger age at resection (p = 0.003) were significant determinants. Male gender was the only risk factor for endoscopic recurrence (OR=1.88, 95% CI: 1.13–3.08). Conclusion Our data suggest rates of post-operative recurrence in line with published data. Risk factors were similar to those identified in the REMIND study, with younger age at diagnosis/resection associated with higher rates of recurrence. Our data suggest sociodemographic deprivation does not influence recurrence rates; however,, more work is needed to validate this. References

scholarly journals Resection Margin Involvement with Crohn's Disease and Postoperative Anastomotic Integrity

1989 ◽  
Vol 3 (3) ◽  
pp. 95-97
Author(s):  
J. Wong ◽  
R.M. Preshaw ◽  
D.F. Reid ◽  
J.K. Kelly
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Resection Margin ◽  
Contrast Enema ◽  
Water Soluble ◽  
Double Blind ◽  
Surgical Specimen ◽  
Margin Involvement ◽  
Water Soluble Contrast ◽  
Anastomotic Breakdown

A prospective double-blind trial was conducted in Crohn's disease subjects in whom a resection was being performed, to assess the hypothesis that marginal disease would adversely influence healing of the anastomosis. Of 106 eligible patients. 51 completed a protocol of pathological assessment of the surgical specimen and a water soluble contrast enema 10 to 15 days after the surgical procedure. Six were found to have radiological leaks and three additional subjects had clinical leaks from the anastomosis. The proportion of leaks, both clinical and radiological, was nine of 54. There was no trend to increasing rate of anastomotic breakdown with increasing marginal disease.

scholarly journals Longer Diagnosis-surgery Duration Is Associated With an Increased Risk of Early Postoperative Complications for Crohn's Disease: A Retrospective Study

2021 ◽  
Author(s):  
Xuanyi Chen ◽  
Siqi Zhang ◽  
Fanru Shen ◽  
Yuan Shi ◽  
Sailiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Crohn’S Disease ◽  
Retrospective Study ◽  
Crohn's Disease ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Early Postoperative Complications ◽  
Increased Risk ◽  
Surgery Duration

Abstract Background: Early postoperative complications(ePOCs) frequently occur in Crohn’s patients after surgery. The risk factors of ePOCs for Crohn’s disease (CD), however, remain controversial. We aimed to assess the incidence and risk factors of ePOCs in CD patients after surgical resection.Methods: The retrospective study was conducted on 97 patients undergoing surgeries between January 2010 and September 2019 for Crohn’s disease in a tertiary hospital in China. Results: In total, 33 patients (34.0%) experienced ePOCs, including 11 intra-abdominal septic complications (11.3%) and 1 postoperative death (1.0%). Severe complications (Dindo–Clavien III–IV) were seen in 8 patients (8.2%). In multivariate analysis, diagnosis-surgery duration exceeding 6 months(odds-ratio [OR]=4.07; confidence interval [CI] 95%[1.10-15.09], P=0.036), serum platelet count <300*1000/mm3(odds-ratio [OR]=6.74; confidence interval [CI] 95%[1.58-28.71], P=0.01) and serum gamma-glutamyl transpeptidase(GGT) level >10U/L(odds-ratio [OR]=9.22; confidence interval [CI] 95%[1.23-68.99], P=0.031)were identified as independent risk factors for ePOCs. Preoperative exposure to anti-tumor necrosis factor (TNF) agents (P=1.00) were not associated with a higher risk of ePOCs. 34.0% of CD patients developed ePOCs after surgical resection.Conclusions: Diagnosis-surgery duration exceeding 6 months, serum platelet count <300*1000/mm3, and serum GGT level >10U/L were associated with an increased risk of ePOCs. Preoperative exposure to anti-TNF agents were not associated with a higher risk of ePOCs.

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