Preoperative Intra-abdominal Sepsis, Not Penetrating Behavior Itself, Is Associated With Worse Postoperative Outcome After Bowel Resection for Crohn Disease

Abstract Background Nucleotide-binding oligomerization domain-containing protein 2 (NOD2) mutations are a genetic risk factor for Crohn disease. Ileocecal resection is the most often performed surgery in Crohn disease. We investigated the effect of Nod2 knockout (KO) status on anastomotic healing after extended ileocecal resection (ICR) in mice. Methods Male C57BL6/J wild-type and Nod2 KO mice underwent an 11 cm resection of the terminal ileum including the cecum. An end-to-end jejuno-colostomy was performed. Animals were killed after 5 days investigating bursting pressure, hydroxyproline content, and expression of matrix metabolism genes, key cytokines, and histology of the anastomosis. Results Mortality was higher in the Nod2 KO group but not because of local or septic complications. Bursting pressure was significantly reduced in the Nod2 KO mice (32.5 vs 78.0 mmHg, P < 0.0024), whereas hydroxyprolin content was equal. The amount of granulation tissue at the anastomosis was similar but more unstructured in the Nod2 KO mice. Gene expression measured by real-time polymerase chain reaction showed significantly increased expression for Collagen 1alpha and for collagen degradation as measured by matrix metalloproteinase-2, -9, and -13 in the Nod2 KO mice. Gelatinase activity from anastomotic tissue was enhanced by Nod2 status. Gene expression of arginase I, tumor necrosis factor-α, and transforming growth factor-ß but not inducible nitric oxide synthase were also increased at the anastomosis in the Nod2 KO mice compared with the control mice. Conclusions We found that Nod2 deficiency results in significantly reduced bursting pressure after ileocecal resection. This effect is mediated via an increased matrix turnover. Patients with genetic NOD2 variations may be prone to anastomotic failure after bowel resection.

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Gallbladder Motility in Crohn Disease: Influence of Disease Localization and Bowel Resection

Scandinavian Journal of Gastroenterology ◽

10.1080/003655200750056628 ◽

2000 ◽

Vol 35 (11) ◽

pp. 1157-1162 ◽

Cited By ~ 15

Author(s):

M. K. Vu, H. A. J. Gielkens, R. A.

Keyword(s):

Crohn Disease ◽

Bowel Resection ◽

Gallbladder Motility

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Prevalence of Sarcopenia and Its Impact on Postoperative Outcome in Patients With Crohn’s Disease Undergoing Bowel Resection

Journal of Parenteral and Enteral Nutrition ◽

10.1177/0148607115612054 ◽

2015 ◽

Vol 41 (4) ◽

pp. 592-600 ◽

Cited By ~ 35

Author(s):

Tenghui Zhang ◽

Lei Cao ◽

Tingzhi Cao ◽

Jianbo Yang ◽

Jianfeng Gong ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Resection ◽

Postoperative Outcome

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C. Difficile Infection in the First Year After Diagnosis is Associated with Shorter Time to Bowel Resection Surgery in Pediatric Crohn Disease

Gastroenterology ◽

10.1016/s0016-5085(17)33249-3 ◽

2017 ◽

Vol 152 (5) ◽

pp. S956

Author(s):

Jennifer Hellmann ◽

Aaron Linn ◽

Kathleen Lake ◽

Ramona Bezold ◽

Lin Fei ◽

...

Keyword(s):

Crohn Disease ◽

Bowel Resection ◽

First Year

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Imaging Features Associated With Failure of Nonoperative Management of Intraabdominal Abscesses in Crohn Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz069 ◽

2019 ◽

Vol 25 (12) ◽

pp. 1939-1944

Author(s):

Daniel Perl ◽

Akbar K Waljee ◽

Shrinivas Bishu ◽

Peter D R Higgins ◽

Ashish P Wasnik ◽

...

Keyword(s):

Retrospective Study ◽

Crohn Disease ◽

Bowel Wall ◽

Nonoperative Management ◽

Bowel Resection ◽

Wall Thickening ◽

Imaging Features ◽

Abdominal Abscess ◽

Abdominal Abscesses ◽

Bowel Wall Thickening

Management of Crohn’s-related intra-abdominal abscesses is challenging. In a retrospective study of patients undergoing non-operative intra-abdominal abscess management, radiographic factors including abscess size, pre-stenotic bowel dilation, and bowel wall thickening are associated with the need for future bowel resection.

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The Influence of Preoperative Medications on Postoperative Complications in Patients After Intestinal Surgery for Crohn’s Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izz010 ◽

2019 ◽

Vol 25 (9) ◽

pp. 1559-1568 ◽

Cited By ~ 6

Author(s):

Chang Sik Yu ◽

Sung Woo Jung ◽

Jong Lyul Lee ◽

Seok-Byung Lim ◽

In Ja Park ◽

...

Keyword(s):

Risk Factors ◽

Crohn’S Disease ◽

Postoperative Complications ◽

Crohn's Disease ◽

Bowel Resection ◽

Abdominal Sepsis ◽

Infectious Complications ◽

Time Of Surgery ◽

Tnf Α ◽

Resection And Anastomosis

Abstract Background Many patients with Crohn’s disease (CD) are treated with medications, including steroids, immunomodulators, and anti–tumor necrosis factor alpha (anti-TNF-α) agents, at the time of surgery. This study evaluated the effects of these medications on postoperative complications in CD patients. Methods This retrospective study analyzed patients who underwent bowel resection for CD between January 2006 and December 2015. Postoperative complications were defined as a Clavien-Dindo classification of grade 2A or higher within the first 30 days after surgery. Results Of the 817 patients enrolled, 687 patients received bowel resection and anastomosis without stoma formation. Of 687 patients, 381 (55.5%) were being treated with preoperative medications at the time of surgery (medication group) and 306 (44.5%) were not (nonmedication group). The overall rate of postoperative complications was not different between the medication and nonmedication groups (23.4% vs 21.9%, P = 0.36). Preoperative treatments with immunomodulators plus anti-TNF-α agents (relative risk [RR], 2.314; 95% confidence interval [CI], 1.126–4.753; P = 0.022) and treatment with immunomodulators plus steroids (RR, 2.536; 95% CI, 1.124–5.725; P = 0.025) were risk factors for infectious complications. Preoperative treatments with immunomodulators plus anti-TNF-α agents (RR, 2.731; 95% CI, 1.102–6.769; P = 0.03) and treatment with immunomodulators plus steroids (RR, 3.118; 95% CI, 1.169–8.320; P = 0.023) were significantly associated with increased risk of intra-abdominal sepsis. Conclusions Preoperative treatments with immunomodulators plus anti-TNF-α agents or steroids were risk factors for infectious complications, especially intra-abdominal sepsis in patients who underwent bowel resection and anastomosis.

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Endovascular Treatment of Ileocolic Pseudoaneurysm After a Laparoscopic-Assisted Bowel Resection for Crohn Disease

Vascular and Endovascular Surgery ◽

10.1177/1538574407308202 ◽

2008 ◽

Vol 42 (2) ◽

pp. 173-175 ◽

Cited By ~ 3

Author(s):

Yair Edden ◽

Noam Shussman ◽

Matan J. Cohen ◽

Anthony Verstandig ◽

Alon J. Pikarsky

Keyword(s):

Endovascular Treatment ◽

Crohn Disease ◽

Bowel Resection ◽

Laparoscopic Assisted

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Current Elective Surgical Treatment of Inflammatory Bowel Disease

10.5772/intechopen.100112 ◽

2021 ◽

Author(s):

Enio Chaves Oliveira ◽

Mauro Bafutto ◽

Alexandre Augusto Ferreira Bafutto ◽

Salustiano Gabriel Neto ◽

Jarbas Jabur Bittar Neto

Keyword(s):

Inflammatory Bowel Disease ◽

Surgical Treatment ◽

Small Bowel ◽

Crohn Disease ◽

Bowel Disease ◽

Bowel Resection ◽

Normal Function ◽

Total Proctocolectomy ◽

Patient Will ◽

Inflammatory Bowel

The incidence of inflammatory bowel disease (IBD) is increasing world-wide and most patient will require some surgical treatment once in life. IBD surgical patients are a challenge to surgeons. Main goals of surgical treatment are (1) to preserve the small bowel integrity because many resections may lead the patient to a small bowel short syndrome and (2) restore normal function as they have absorption disturbances. IBD patients may present mal-nutrition status and/or immunosuppression at the time of surgery. Types of surgery range from a simple plasty in Crohn disease to a total proctocolectomy in Ulcerative Colitis. For Crohn disease most procedures avoid resection and use diseased segments to prevent disabsorption. Herein we describe the most currently used techniques to treat IBD patients, when to indicate surgery and how to prepare them to less outcomes. Patients with Crohn disease with high risk for short bowel syndrome and intestinal failure should be submitted to Strictureplasty otherwise, Bowel Resection is the favored surgical technique for the management of fibrostenotic. Bowel Resection is associated with lower recurrence rate and longer recurrence-free survival.

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Liver Transplantation in Children and Impact of Intra-operative Goal Directed Therapies on Postoperative Outcome

10.21203/rs.3.rs-744584/v2 ◽

2021 ◽

Author(s):

Claudine Kumba

Keyword(s):

Liver Transplantation ◽

Point Of Care ◽

Secondary Analysis ◽

Postoperative Outcome ◽

Initial Study ◽

Abdominal Sepsis ◽

Postoperative Outcomes ◽

Transfusion Rate ◽

Complication Rates ◽

Intraoperative Management

Abstract Background: Liver transplantation is a hemorrhagic surgery with high postoperative complication rates in terms of organ dysfunction and infections. We conducted a retrospective observational monocentric study that had the objectives of determining predictors of postoperative outcome in children. In the initial cohort, 19 children underwent liver transplantation. A description of the postoperative outcomes of these patients was undertaken.Objective: To describe intraoperative and postoperative outcomes in children undergoing liver transplantation and to propose intraoperative management implementation measures for postoperative outcome improvement.Methods: Secondary analysis of liver transplanted patients included in the initial study.Results: There were 19 patients who underwent liver transplantation with a median age of 31[2-154] months. Five patients had re-operations (26.3%). Fourteen (73.7%) had intraoperative and/or postoperative complications. Five (26.3%) had intraoperative hemorrhagic shock. One (5.3%) had postoperative respiratory failure, one (5.3%) had postoperative multiple organ failure, two (10.5%) had postoperative neurologic failure and five (26.3%) had cardio-circulatory failure. One (5.3%) had postoperative pulmonary sepsis, five (26.3%) had postoperative abdominal sepsis, and six (31.6%) had postoperative septicemia. Intra-operative transfusion rate was 100%. In-hospital mortality rate was 10.5% (two patients).Conclusion: There were multiple postoperative adverse outcome predictors. Optimal intraoperative patient management with transfusion guided by point-of-care viscoelastic devices and goal-directed fluid and hemodynamic therapy with validated parameters and tools in children is a possible pathway to upgrade postoperative evolution in pediatric liver transplantation.

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