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 Surgical Treatment for Crohn's Disease: A Role of Kono-S Anastomosis in the West

2020 ◽  
Vol 33 (06) ◽  
pp. 335-343
Author(s):  
Toru Kono ◽  
Alessandro Fichera
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Symptoms ◽  
Standard Of Care ◽  
Disease Recurrence ◽  
Current Data ◽  
Repeat Surgery ◽  
Surgical Recurrence ◽  
End To End ◽  
Mesenteric Excision

AbstractMore than 80% of patients with Crohn's disease (CD) will require surgical intervention during their lifetime, with high rates of anastomotic recurrence and stenosis necessitating repeat surgery. Current data show that pharmacotherapy has not significantly improved the natural history of postoperative clinical and surgical recurrence of CD. In 2003, antimesenteric hand-sewn functional end-to-end (Kono-S) anastomosis was first performed in Japan. This technique has yielded very desirable outcomes in terms of reducing the incidence of anastomotic surgical recurrence. The most recent follow-up of these patients showed that very few had developed surgical recurrence. This new approach is superior to stapled functional end-to-end anastomosis because the stumps are sutured together to create a stabilizing structure (a “supporting column”), serving as a supportive backbone of the anastomosis to help prevent distortion of the anastomotic lumen due to disease recurrence and subsequent clinical symptoms. This technique requires careful mesenteric excision for optimal preservation of the blood supply and innervation. It also results in a very wide anastomotic lumen on the antimesenteric side. The Kono-S technique has shown efficacy in preventing surgical recurrence and the potential to become the new standard of care for intestinal CD.

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.

Small-bowel lymphoma complicating long-standing Crohn's disease.

1997 ◽  
Vol 169 (5) ◽  
pp. 1462-1463 ◽  
Author(s):  
H E Woodley ◽  
J A Spencer ◽  
K A MacLennan
Keyword(s):  
Crohn’S Disease ◽  
Small Bowel ◽  
Crohn's Disease

ACTIVATED INTESTINAL MUSCLE CELLS PROMOTE PREADIPOCYTE MIGRATION: A NOVEL MECHANISM OF CREEPING FAT FORMATION IN CROHN’S DISEASE

2021 ◽  
Vol 27 (Supplement_1) ◽  
pp. S34-S34
Author(s):  
Ren Mao ◽  
Genevieve Doyon ◽  
Ilyssa Gordon ◽  
Jiannan Li ◽  
Sinan Lin ◽  
...  
Keyword(s):  
Extracellular Matrix ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Ex Vivo ◽  
Muscularis Propria ◽  
Dominant Factor ◽  
Stricture Formation ◽  
Intestinal Tissue ◽  
Mesenteric Fat

Abstract Background and Aims Creeping fat, the wrapping of mesenteric fat around the bowel wall, is a typical feature of Crohn’s disease, and is associated with stricture formation and bowel obstruction. How creeping fat forms is unknown, and we interrogated potential mechanisms using novel intestinal tissue and cell interaction systems. Methods Tissues from normal, ulcerative colitis, non-strictured and strictured Crohn’s disease intestinal specimens were obtained. Fresh and decellularized tissue, mesenteric fat explants, primary human adipocytes, pre-adipocytes, muscularis propria cells, and native extracellular matrix were used in multiple ex vivo and in vitro systems involving cell growth, differentiation and migration, proteomics, and integrin expression. Results Crohn’s disease muscularis propria cells produced an extracellular matrix scaffold which is in direct spatial and functional contact with the immediately overlaid creeping fat. The scaffold contained multiple proteins, but only fibronectin production was singularly upregulated by TGF-b1. The muscle cell-derived matrix triggered migration of pre-adipocytes out of mesenteric fat, fibronectin being the dominant factor responsible for their migration. Blockade of α5β1 on the pre-adipocyte surface inhibited their migration out of mesenteric fat and on 3D decellularized intestinal tissue extracellular matrix. Conclusion Crohn’s disease creeping fat appears to result from the migration of pre-adipocytes out of mesenteric fat and differentiation into adipocytes in response to an increased production of fibronectin by activated muscularis propria cells. These new mechanistic insights may lead to novel approaches for prevention of creeping fat-associated stricture formation.

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