Risk factors for postoperative complications after surgery in complicated Crohn’s disease

2021 ◽  
pp. 44-52
Author(s):  
A.V. Vardanyan ◽  
M.V. Shapina ◽  
A.V. Poletova ◽  
S.I. Achkasov
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Conservative Treatment ◽  
Postoperative Period ◽  
Right Hemicolectomy ◽  
Male Gender ◽  
Ileocecal Resection ◽  
Short Operative Time ◽  
Stoma Formation ◽  
Complications Rate

Aim: to improve results of the surgical treatment of Crohn’s disease. Patients and Methods: 162 patients were included. 69 (42,6 %) — received preoperative conservative treatment. Ileocecal resection was performed in 148 (91,4 %), in 5 (3,1 %) cases — part of jejunum resection, ileum resection — in 3 (1,8 %) patients and right hemicolectomy — 6 (3,7 %). Stoma formation was in 104 (64,2 %) patients. Complications were registered in 25 (15,4 %) cases. Results: in univariant analysis it was found that young age up to 40 years, male gender and short operative time ( 150 min) are the predictors (р = 0,03, р = 0,03 и р = 0,02, respectively) to noncomplicated postoperative period (reduce risk in 10, 5 и 10 fold, respectively). The absence of conservative treatment before surgery increased the complications’ rate more than 3 times comparing to patients who received therapy (OR 3,2 CI 95 % 0,1–11,45; р = 0,06), but we failed to get significance, that is why multivariant analysis was carried out to see the influence of all clinical factors on non-treated patients. Significance was found in all models. Conclusion: male gender (OR 0,2 CI 95 % 0,01–2,02; р = 0,02), the age younger than 40 (OR 0,1 CI 95 % 0,02–0,9; р = 0,03) and the duration of the operation less than 150 minutes (OR 0,1 CI 95 % 0,01–2,02; р = 0,03) is associated with the reduction of complications in the postoperative period. Preoperative conservative treatment during 3 months allows to decrease the rate of complications to 3,5 times (OR 3,5 CI 95 % 1,2–9,8; р = 0,01) and risk of the stoma formation — to 7 times (χ2 = 7,56; р = 0,006).

scholarly journals P171 Does microscopic involvement of the surgical margins after ileocececal resection in Crohn’s disease patients predicts early recurrence?

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S223-S223
Author(s):  
M ZEMEL ◽  
E Solo ◽  
J Klausner ◽  
H Tulchinsky
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Disease Recurrence ◽  
Male Gender ◽  
Stapled Anastomosis ◽  
Perianal Disease ◽  
Ileocecal Resection ◽  
Resected Specimen ◽  
Histopathological Evidence

Abstract Background Past research has identified different factors which are associated with post-operative recurrence of Crohn’s disease (CD). However, controversy remained whether the microscopic presence of CD in the margins of the resected specimen increases the risk of recurrence. The main aim of our study was to determine whether microscopic presence of CD in the resected specimen margin in patients who underwent ileocecal resection predicts disease recurrence. The secondary aim was to identify other risk factors for recurrence. Methods We retrospectively evaluated all CD patients who underwent ileocecal resection in our unit between 2000 and 2015. The diagnoses of CD and information regarding the margins’ involvement were retrieved from pathology reports. Recurrence was indicated according to medical records or according to specific phone questionnaire. Demographic and clinical parameters where compared between patients with and without histopathological evidence of CD in the resected margins. Results 202 CD patients were included: 49 patients with histopathological evidence of CD in the resected margins and 153 patients without involvement. The main demographic characteristics were similar. Patients who received preoperative medical treatment had statistically significant higher rate of uninvolved margins (90.8 vs. 77.6%, p = 0.03). Technical aspects including surgical approach, conversion rates to open surgery, and anastomotic methods were similar. Likewise, the post-operative course regarding medical treatment, endoscopic and clinical recurrence, and reoperation rates was also similar. We found a statistically significant shorter time for disease recurrence in laparoscopic surgery (HR 1.6, CI 1.1–2., p = 0.02(, stapled anastomosis (HR 1.7, CI 1.2–2.6, p = 0.01), if stricturoplasty was done in addition to the ileocecal resection (HR 1.7, CI 1.1–2.6, p = 0.02(, and in patients with perianal disease (HR 1.7, CI 1.1–2.6, p = 0.02(. Male gender and conversion from laparoscopic to open surgical technique had increased HR but did not reach statistical significance. Conclusion The presence of microscopic CD at the resection margins was not associated with disease recurrence. We found that male gender, perianal disease, laparoscopic approach, conversion to laparotomy and stapled anastomosis were associated with early disease recurrence. Our results support a conservative approach in the determination of the extent of resection in CD patients having ileocecal resection.

scholarly journals Capsule Retentions and Incomplete Capsule Endoscopy Examinations: An Analysis of 2300 Examinations

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Charlotte M. Höög ◽  
Lars-Åke Bark ◽  
Juan Arkani ◽  
Jacob Gorsetman ◽  
Olle Broström ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Capsule Endoscopy ◽  
Male Gender ◽  
Large Series ◽  
Older Age ◽  
Safe Procedure ◽  
Capsule Retention

Aim. To evaluate capsule endoscopy in terms of incomplete examinations and capsule retentions and to find risk factors for these events.Material and Methods. This retrospective and consecutive study includes data from 2300 capsule enteroscopy examinations, performed at four different hospitals in Stockholm, Sweden from 2003 to 2009.Results. The frequency of incomplete examinations was 20%. Older age, male gender, suspected, and known Crohn's disease were risk factors for an incomplete examination. The PillCam capsule had the highest rate of completed examinations. Capsule retention occurred in 1.3% (). Risk factors for capsule retention were known Crohn's disease and suspected tumor. Complications of capsule retention were acute obstructive symptoms in six patients and one death related to complications after acute surgical capsule retrieval.Conclusion: Capsule endoscopy is considered a safe procedure, although obstructive symptoms and serious complications due to capsule retention can be found in a large series of patients.

scholarly journals Predictive value of tissue calprotectin for disease recurrence after ileocecal resection in pediatric Crohn's disease

2021 ◽  
Author(s):  
Kristyna Zarubova ◽  
Ondrej Fabian ◽  
Ondrej Hradsky ◽  
Tereza Lerchova ◽  
Filip Mikus ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Predictive Value ◽  
Disease Recurrence ◽  
Ileocecal Resection

Mucosal Recolonization after Ileocecal Resection Differs in Crohn's Disease Patients Developing Postoperative Recurrence

2017 ◽  
Vol 152 (5) ◽  
pp. S990
Author(s):  
Kathleen Machiels ◽  
Marta Pozuelo del Río ◽  
João Sabino ◽  
Alba Santiago ◽  
David Campos ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Postoperative Recurrence ◽  
Ileocecal Resection

Long-term outcomes after elective ileocecal resection in children with active localized Crohn's disease—a multicenter European study

2015 ◽  
Vol 50 (10) ◽  
pp. 1630-1635 ◽  
Author(s):  
Iva Hojsak ◽  
Sanja Kolacek ◽  
Lars Folmer Hansen ◽  
Jiri Bronsky ◽  
Maija Piekkala ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Ileocecal Resection ◽  
European Study ◽  
Long Term Outcomes

Crohn’s disease of the gallbladder

2021 ◽  
Vol 14 (9) ◽  
pp. e243579
Author(s):  
Callam Scott ◽  
Amit Patel ◽  
Noori Maka ◽  
Jonathan C MacDonald
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Gallstone Formation ◽  
Right Hemicolectomy ◽  
Chronic Cholecystitis ◽  
Pathological Examination ◽  
Key Factors ◽  
Chronic Inflammatory Condition ◽  
History Of ◽  
Lymphoid Aggregates

Crohn’s disease (CD) is a chronic inflammatory condition, which typically involves the small and large bowel but can affect any part of the gastrointestinal tract. Common symptoms include abdominal pain, diarrhoea, fatigue, weight loss and malnutrition. Complications of CD include gallstone formation and cholecystitis. Impaired reabsorption of bile salts in the small bowel and CD-related surgeries are key factors in the development of CD-related gallstones, although other factors are also important. Direct CD-related inflammation of the gallbladder is very unusual and the typical histological features of CD are rarely encountered in cholecystectomy specimens of individuals with CD. We present a case of a man in his early 60s with CD, previous right hemicolectomy and a history of gallstones, who presented with chronic cholecystitis. Following cholecystectomy, pathological examination of the gallbladder unexpectedly demonstrated typical features of CD, including lymphoid aggregates and non-caseating mucosal granulomata.

scholarly journals Experiences with the Kono-S anastomosis in Crohn’s disease of the terminal ileum—a cohort study

2020 ◽  
Author(s):  
K. Horisberger ◽  
D. L. Birrer ◽  
A. Rickenbacher ◽  
M. Turina
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Postoperative Complications ◽  
Crohn's Disease ◽  
Terminal Ileum ◽  
Ileocecal Resection ◽  
Anastomotic Recurrence ◽  
Short Term ◽  
Recurrence Rates

Abstract Purpose The most frequent long-term complication after ileocecal resection in Crohn’s disease is anastomotic recurrence and subsequent stenosis. Recurrence typically begins at the site of the anastomosis, raising the question of whether the surgical technique of the anastomosis could affect recurrence rates. Kono-S anastomosis is a hand-sewn antimesenteric functional end-to-end anastomosis that offers a wide lumen that is well accessible for endoscopic dilatation. The purpose of our study is to review the rate of postoperative complications almost 2 years after the introduction of this technique. Materials and methods This is a prospective single-center cohort study of all consecutive patients with Crohn’s disease undergoing ileocecal resection. Patients’ characteristics as well as specific data for the surgical procedure and short-term outcome were evaluated. Results Thirty patients were operated for Crohn’s disease of the terminal ileum (n = 24) or anastomotic recurrence (n = 6). Postoperative complications with a Clavien-Dindo Score ≥ IIIb were observed in three patients. One patient showed a hemorrhage and underwent surgical hemostasis. Two patients developed anastomotic leakage; in both cases, ileostomy was created after resection of the anastomosis. The median hospital stay was 9 days (IQR 7–12). A comparison with a historic group of conventionally operated patients of our hospital revealed no differences in short-term results except for the duration of surgery. Conclusion The Kono-S anastomosis is associated with acceptable short-term results, complications, and recurrence rates comparable with the established anastomotic techniques. Longer operation times are observed, but the few published studies concerning long-term recurrence are promising.

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