scholarly journals Abdominal Surgery in Crohn’s Disease: Risk Factors for Complications

2020 ◽  
pp. 1-7
Author(s):  
Cintia Mayumi Sakurai Kimura ◽  
Arceu Scanavini Neto ◽  
Natalia Sousa Freitas Queiroz ◽  
Natally Horvat ◽  
Mariane Gouvea Monteiro Camargo ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Disease Risk ◽  
Factors Associated ◽  
Urgent Surgery ◽  
Preoperative Optimization ◽  
Increased Risk ◽  
Disease Location

<b><i>Introduction:</i></b> Abdominal surgery in patients with Crohn’s disease (CD) is challenging, especially in the biologic era. The aim of this study was to evaluate factors associated with increased risk for postoperative complications in CD. <b><i>Methods:</i></b> A retrospective study was conducted with consecutive patients who underwent abdominal surgery for CD from January 2012 to January 2018. <b><i>Results:</i></b> Of 103 patients, 32% had postoperative complications. Gender, age, disease location and phenotype, hemoglobin and albumin levels, previous abdominal surgery, and preoperative optimization did not differ between the groups with or without complications. Thirty-five percent of the patients were under anti-TNF therapy, and this medication was not associated with increased risk for postoperative complications. Time since the onset of the disease was significantly higher in patients with complications (12.9 vs. 9.4, <i>p</i> = 0.04). In multivariate analysis, creation of ostomy and urgent surgery were the only variables independently associated with increased risk for complications (OR 3.2, 95% CI 1.12–9.46 and OR 2.94, 95% CI 0.98–9.09, respectively). <b><i>Conclusion:</i></b> Urgent surgery for CD should preferably be performed in specialized centers, and creation of stoma is not necessarily associated with lower rate of postoperative complications but rather less severe complications.

Anti-TNF and Postoperative Complications in Abdominal Crohn's Disease Surgery

2019 ◽  
Vol 20 (13) ◽  
pp. 1339-1348 ◽  
Author(s):  
Takayuki Yamamoto ◽  
Fabio Vieira Teixeira ◽  
Rogerio Saad-Hossne ◽  
Paulo Gustavo Kotze ◽  
Silvio Danese
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Small Sample Size ◽  
Infectious Complications ◽  
Small Sample ◽  
Increased Risk ◽  
Tnf Α ◽  
Meta Analyses

Background: : Biological therapy with anti-Tumour Necrosis Factor (TNF)-α agents revolutionised the treatment of inflammatory bowel disease over the last decades. However, there may be an increased risk of postoperative complications in Crohn’s disease (CD) patients treated with anti-TNF-α agents prior to abdominal surgery. Objective:: To evaluate the effects of preoperative anti-TNF-α therapy on the incidence of complications after surgery. Methods: : A critical assessment of the results of clinical trial outcomes and meta-analyses on the available data was conducted. Results: : Based on the outcomes of previous reports including meta-analyses, preoperative use of anti- TNF-α agents modestly increased the risk of overall complications and particularly infectious complications after abdominal surgery for CD. Nevertheless, previous studies have several limitations. The majority of them were retrospective research with heterogeneous outcome measures and single centre trials with relatively small sample size. In retrospective studies, the standard protocol for assessing various types of postoperative complications was not used. The most serious limitation of the previous studies was that multiple confounding factors such as malnutrition, use of corticosteroids, and preoperative sepsis were not taken into consideration. Conclusion:: Among patients treated with preoperative anti-TNF-α therapy, the risk of overall complications and infectious complications may slightly increase after abdominal surgery for CD. Nevertheless, the previous reports reviewed in this study suffered from limitations. To rigorously evaluate the risk of anti-TNF-α therapy prior to surgery, large prospective studies with standardised criteria for assessing surgical complications and with proper adjustment for confounding variables are warranted.

scholarly journals Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease

2012 ◽  
Vol 1 ◽  
pp. 13-19
Author(s):  
Katarzyna Borycka-Kiciak ◽  
Adam Kiciak ◽  
Łukasz Janaszek ◽  
Paweł Jaworski ◽  
Wiesław Tarnowski
Keyword(s):  
Risk Factor ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Purine Analogues

The Impact of Anti-Tumor Necrosis Factor Alpha Therapy on Postoperative Complications in Pediatric Crohn's Disease

2019 ◽  
Vol 30 (01) ◽  
pp. 027-032
Author(s):  
Vojtech Dotlacil ◽  
Jiri Bronsky ◽  
Ondrej Hradsky ◽  
Barbora Frybova ◽  
Stepan Coufal ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Tumor Necrosis Factor ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Tumor Necrosis ◽  
Tnf Α ◽  
Significant Difference ◽  
The Impact ◽  
Necrosis Factor

Abstract Introduction The incidence of Crohn's disease (CD) within the pediatric population is increasing worldwide. Despite a growing number of these patients receiving anti-tumor necrosis factor α therapy (anti-TNF-α), one-third of them still require surgery. There is limited data as to whether anti-TNF-α influences postoperative complications. We evaluated postoperative complications in patients who were or were not exposed to anti-TNF-α therapy in our institutional cohort. Materials and Methods A retrospective review of CD patients who underwent abdominal surgery between September 2013 and September 2018 was performed. The patients were divided into two groups based on whether they were treated with anti-TNF-α within 90 days before surgery. Thirty-day postoperative complications were assessed using Clavien–Dindo classification (D-C); this examination included surgical site infections (SSIs), stoma complications, intra-abdominal septic complications, non-SSIs, bleeding, ileus, readmission rate, and return to the operating room. Mann–Whitney U-test, Fisher's exact test, and multivariate logistic regression analyses were used for statistical analysis. Results Sixty-five patients (41 males) with a median age of 16 years (range: 7–19) at the time of operation were identified. The most common surgery was ileocecal resection in 49 (75%) patients. Forty-three (66.2%) patients were treated with anti-TNF-α preoperatively. Seven patients (11%) experienced postoperative complications. There was no statistically significant difference in postoperative complication in patients who did or did not receive anti-TNF-α before surgery (D-C minor 2.3% vs. 4.6%, p = 1; D-C major 7% vs. 9.1%, p = 1). Conclusion The use of anti-TNF-α in pediatric CD patients within the 90 days prior to their abdominal surgery was not associated with an increased risk of 30-day postoperative complications.

Body mass index: Implications on disease severity and postoperative complications in patients with Crohn’s disease undergoing abdominal surgery

Surgery ◽  
2019 ◽  
Vol 166 (4) ◽  
pp. 703-708 ◽  
Author(s):  
Nicholas P. McKenna ◽  
Elizabeth B. Habermann ◽  
Martin D. Zielinski ◽  
Amy L. Lightner ◽  
Kellie L. Mathis
Keyword(s):  
Body Mass Index ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Disease Severity ◽  
Body Mass

scholarly journals P145 Inflammatory Bowel Disease patients requiring surgery can be treated in referral centres regardless of the COVID-19 status of the hospital: results of a multicentric European study during the first COVID-19 outbreak (COVIBD-Surg)

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S228-S229
Author(s):  
M Rottoli ◽  
G Pellino ◽  
M Tanzanu ◽  
C Baldi ◽  
A Frontali ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Predictive Variables ◽  
Urgent Surgery ◽  
Inflammatory Bowel ◽  
Selection Operator

Abstract Background Little is known regarding the outcomes of inflammatory bowel disease (IBD) patients who required surgery during the outbreak of Coronavirus disease 19 (COVID-19). This study aimed to compare outcomes of IBD patients undergoing surgery in COVID-19-treatment and COVID-19-free hospitals. Methods Retrospective study involving patients undergoing IBD surgery in seven centres (six COVID-19-treatment hubs and one COVID-free hospital) across 5 European countries during the period of highest reduction of elective activity due to the first peak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Predictive variables of the risk of moderate-to-severe postoperative complications were analysed using logistic regression analysis. Considering the large number of regressors and the risk of over-fitting due to the small number of events, the least absolute shrinkage and selection operator (LASSO) method was used. Results Of the 91 patients (59 males, 64.8%) with Crohn’s disease (54, 59.3%) or ulcerative colitis (37, 40.7%), 66 (72.5%) had surgery in a COVID-19-treatment hospital, while 25 (27.5%) were treated in the COVID-19-free centre. A higher proportion of COVID-19-treatment patients required urgent surgery (48.4% vs 24%, p=0.035), did not discontinue the biologic therapy (15.1% vs. 0%, p=0.039), underwent surgery without a SARS-CoV-2 test (19.7% vs. 0%, p=0.0033), and were admitted to intensive care postoperatively (10.6% vs. 0%, p=0.032). Three patients (4.6%) of the COVID-19-treatment group had a SARS-CoV-2 infection during the hospital course. Use of steroids at surgery (Odds ratio [OR]=4.10, 95% CI 1.14–15.3, p=0.03), presence of comorbidities (OR=3.33, 95% CI 1.08–11, p=0.035), and Crohn’s disease (vs. ulcerative colitis, OR=3.82, 95% CI 1.14–15.4, p=0.028) were associated with risk of moderate-to-severe postoperative complications. The admission to a COVID-19-treatment hospital was not associated with higher risks of complications (OR 2.06, 95% CI 0.54–10.4, p=0.30) Conclusion Although a SARS-CoV-2 infection in the postoperative period represented a concrete risk in IBD patients undergoing surgery in COVID-19-treatment hospitals, the study showed that IBD patients can undergo surgery regardless of the COVID-19-status of the referral centre. The study also showed the lack of standardized practice for IBD patients requiring surgery during the COVID-19 outbreak.

W1233 Genotype-Subphenotype Correlations Between Established Crohn's Disease Risk Alleles and Disease Location

2010 ◽  
Vol 138 (5) ◽  
pp. S-680
Author(s):  
Alexander Lee ◽  
Terry Z. Li ◽  
Hongyan Chen ◽  
Tianyi Zhang ◽  
Wei Zhu ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Risk ◽  
Risk Alleles ◽  
Disease Location

scholarly journals PREDICTIVE FACTORS FOR COMPLETE AND INCOMPLETE EVALUATION OF SMALL INTESTINE BY ENDOSCOPIC CAPSULE

2020 ◽  
Vol 33 (2) ◽  
Author(s):  
Andréia Sopran SCOPEL ◽  
Fernando Issamu TABUSHI ◽  
Luis Fernando Kubrusly ◽  
Paula Bechara POLETTI ◽  
Artur Adolfo PARADA ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Capsule Endoscopy ◽  
Endoscopic Evaluation ◽  
Factors Associated ◽  
Previous Abdominal Surgery ◽  
Endoscopic Capsule ◽  
A Prospective Study ◽  
Endoscopic Methods

ABSTRACT Background: The small-bowel is the most difficult segment to be visualized by traditional endoscopic methods. The need for its exploration led to the development of capsule endoscopy. The percentage of the complete examination varies and still remains uncertain the factors that influence the complete and incomplete examination. Aim: Evaluate the factors that interfere with the completeness of the endoscopic evaluation by the capsule. Methods: A prospective study in which were included 939 patients divided into two groups: complete group (CG) and incomplete group (IG). The studied variables that could interfere were: age, gender, comorbidities, diagnosis of Crohn’s disease, previous abdominal surgery, inadequate preparation to compare the groups reached and did not reach the cecum. Results: Of the 939 patients included 879 (93.3%) reached the cecum (CG) and 63 (6.7%) IG no. The IG was composed of 29 (46.0%) men and 34 (54.0%) women with a mean age of 49.7 years; comorbidities this group accounted for 46% of which 15.9% was Crohn’s disease, previous abdominal surgery 22.2% and 17.5% inadequate preparation. Conclusion: Factors associated with complete or incomplete outcome of the examination with capsule endoscopy were: associated comorbidities, Crohn’s disease, previous abdominal surgery and inadequate preparation.

Vedolizumab in the Perioperative Management of Inflammatory Bowel Disease

2019 ◽  
Vol 20 (13) ◽  
pp. 1317-1322 ◽  
Author(s):  
Amy L. Lightner ◽  
Edward V. Loftus ◽  
Nicholas P. McKenna ◽  
Laura E. Raffals
Keyword(s):  
Inflammatory Bowel Disease ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Bowel Disease ◽  
Perioperative Management ◽  
Chronically Ill ◽  
Infectious Complications ◽  
Increased Risk ◽  
Inflammatory Bowel

Background: : The isolated effect of vedolizumab on increased postoperative complications remains debated, similar to the controversial data on anti-TNF and postoperative complications. Objective: : To determine the risk of vedolizumab on postoperative complications. Method:: A review of the literature available to date on studies comparing postoperative outcomes in vedolizumab-treated versus non-vedolizumab-treated patients was performed. Studies were stratified by those which combined all inflammatory bowel disease together, those specifically focusing on Crohn’s disease or ulcerative colitis individually, and those which included pediatric patients alone. Results:: The data remains controversial in both the adult and pediatric literature regarding the association of vedolizumab and increased postoperative complications. The strongest association between vedolizumab and an increased risk of postoperative infectious complications seems to be in the Crohn’s disease literature. Conclusion:: Vedolizumab may be associated with an increased risk of postoperative infectious complications in Crohn’s disease, but the literature remains controversial due to difficulty in isolating the effect of the biologic alone in a chronically ill, heterogeneous patient population who are on multiple medications including corticosteroids.

Immunosuppressed Patients with Crohn’s Disease Are at Increased Risk of Postoperative Complications: Results from the ACS-NSQIP Database

2019 ◽  
Vol 23 (6) ◽  
pp. 1188-1197 ◽  
Author(s):  
Maria Abou Khalil ◽  
Jad Abou-Khalil ◽  
Jennifer Motter ◽  
Carol-Ann Vasilevsky ◽  
Nancy Morin ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Acs Nsqip ◽  
Increased Risk ◽  
Immunosuppressed Patients ◽  
Acs Nsqip Database

scholarly journals P196 Colon-involving versus non-colon-involving Crohn’s disease classification: is the Montreal classification outdated?

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S262-S262
Author(s):  
T Capela ◽  
V Macedo Silva ◽  
M Freitas ◽  
T Cúrdia Gonçalves ◽  
F Dias de Castro ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Abdominal Surgery ◽  
Adverse Outcomes ◽  
Disease Classification ◽  
Need For Treatment ◽  
Montreal Classification ◽  
Disease Extension ◽  
Disease Behavior ◽  
Disease Location

Abstract Background An appropriate disease classification is essential for the management of Crohn’s disease (CD) patients. Recently, a new classification of colon-involving versus non-colon-involving disease extension was considered to be more predictive of adverse outcomes than the Montreal classification (MRC). We aimed to investigate the association of a colon-based classification with clinically relevant outcomes in patients with CD compared with the MRC. Methods Retrospective cohort-study which consecutively included adult CD patients with at least 1 year of follow-up. Patients were categorized into colon-involving and non-colon-involving disease and according to the MRC. Patients’ demographic, clinical, biochemical, and imaging data were recorded and compared between the two classifications. The primary outcome was the need for treatment with steroids or biologics, hospitalization and major abdominal surgery. Results Of 327 patients, 52.3% were female with a mean age of 43.3±13.1 years. The most common disease location according to MRC was L1 (48.9%), followed by L3 (41.3%) and L2 (9.8%). Overall, 51.1% of patients had colon-involving disease. Although patients with colon-involvement at diagnosis had higher frequency of perianal lesions (27.5% vs 16.9%, P&lt;0.05) and serum inflammatory biomarkers (lower hemoglobin, and higher leucocyte and platelet counts, c-reactive protein and erythrocyte sedimentation rate), this classification was not predictive of relevant outcomes. Considering the two types of colon-involving disease (L2, L3), patients with L2 disease had higher extraintestinal manifestations (43.8% vs 20.7%, respectively, P&lt;0.05), higher B1 disease behavior (87.5% vs 58.5%, respectively, P&lt;0.05) and lower B2 disease behavior (6.25% vs 22.2%, respectively, P&lt;0.05). Disease location according to MRC was predictive of the need for treatment with biologics, hospitalization and major abdominal surgery in univariate analysis, but not in multivariate analysis. Conclusion Although simpler, defining Crohn’s disease extension by colon-involving versus non-colon-involving is not more predictive of adverse outcomes than the Montreal classification. Therefore, the use of Montreal Classification should still be considered essential in the adequate management of IBD patients.

Sign in / Sign up

Export Citation Format

Share Document