Ileocolic Resection For Crohn's Disease Research Articles

Ileocolic resection with temporary ileostomy for Crohn's disease: does it affect long‐term disease recurrence compared with primary anastomosis?

AbstractBackgroundWe aimed to assess whether the risk of disease recurrence in Crohn's disease (CD) patients that undergone ileocolic resection (ICR) with temporary ileostomy and a later stoma reversal is different compared to patients that underwent a one‐stage operation.MethodsA single‐center retrospective review of all patients that underwent elective primary ICR for CD between 2010 and 2022 divided into: 2S‐ICR group‐patients who underwent two‐stage ICR. 1S‐ICR group‐patients who underwent one‐stage ICR.ResultsThe cohort included 191 patients (mean age 33.4, range 15–70), with 40 and 151 patients in the 2S‐ICR and 1S‐ICR groups, respectively. The 2S‐ICR were more comorbid, with a lower mean BMI (18 vs. 21.3, P < 0.001), higher median ASA score (3 vs. 2, P = 0.036), higher percentage on pre‐operative total parenteral nutrition (TPN) (62.5% vs. 24.5%, P < 0.001), and lower levels of pre‐operative albumin (3.3 g/dL vs. 3.8 g/dL, P < 0.001). There were no significant differences in the overall postoperative complication rate (47.5% vs. 47.7% respectively, P = 1), nor in the rate of severe complications (17.5% vs. 13.2%, P = 0.6), but, the 2S‐ICR had a longer post‐operative length‐of‐stay (14 vs. 6 days, P < 0.001) and higher rates of 30‐day readmission (30% vs. 13.2%, P = 0.017). After an overall median follow‐up of 63 months, the groups showed similar rates of endoscopic, clinical, and surgical recurrence.ConclusionsTwo‐stage ICR with a temporary ileostomy does not change long‐term CD recurrence rates compared with one‐stage ICR.

How Reliable Is Endoscopic Scoring of Postoperative Recurrence in Crohn Disease?: A Systematic Review and Meta-Analysis.

Guidelines advise to perform endoscopic surveillance following ileocolic resection (ICR) in Crohn disease (CD) for timely diagnosis of recurrence. This study aims to assess the variation in endoscopic recurrence (ER) rates in patients after ICR for CD using the most commonly used classification systems, the Rutgeerts score (RS) and modified Rutgeerts score (mRS) classifications. A systematic literature search using MEDLINE, Embase, and the Cochrane Library was performed. Randomized controlled trials and cohort studies describing ER < 12 months after an ICR for CD were included. Animal studies, reviews, case reports (<30 included patients), pediatric studies, and letters were excluded. The Newcastle-Ottawa Quality Assessment Scale and Cochrane Collaboration's tool were used to assess risk of bias. Main outcome was the range of ER rates within 12 months postoperatively, defined as RS ≥ i2 and/or mRS ≥ i2b. A proportional meta-analysis was performed. The final search was performed on January 4, 2022. The study was registered at PROSPERO, CRD42022363208. Seventy-six studies comprising 7751 patients were included. The weighted mean of ER rates in all included studies was 44.0% (95% confidence interval, 43.56-44.43). The overall range was 5.0% to 93.0% [interquartile range (IQR), 29.2-59.0]. The weighted means for RS and mRS were 44.0% and 41.1%, respectively. The variation in ER rates for RS and mRS were 5.0% to 93.0% (IQR, 29.0-59.5) and 19.8% to 62.9% (IQR, 37.3-46.5), respectively. Within studies reporting both RS and mRS, the weighted means for ER were 61.3% and 40.6%, respectively. This study demonstrates a major variation in ER rates after ICR for CD, suggesting a high likelihood of inadequate diagnosis of disease recurrence, with potentially impact on quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Factors associated with stoma formation in ileocolic resection for Crohn's disease and the development of a predictive scoring system.

The likelihood of a stoma following ileocolic resection (ICR) for Crohn's disease (CD) is an important consideration. This study aims to identify the factors associated with an increased likelihood of a stoma and develop a predictive scoring system (SS). Patient data were collected from St. Marks Hospital, London, UK and Humanitas Clinical and Research Center, Milan, Italy, on all patients who underwent an ICR for CD from 2005 to 2017. A logistic regression analysis was used for multivariate analysis. The SS was developed from the logistic regression model. The performance of the SS was evaluated using receiver operating characteristics area under the curve (AUROC). A total of 628 surgeries were included in the analysis. Sixty-nine surgeries were excluded due to missing data. The remaining 559 were divided into two cohorts for the scoring system's development (n = 434) and validation (n = 125). The regression model was statistically significant (p < 0.0001). The statistically significant independent variables included sex, preoperative albumin and haemoglobin levels, surgical access and simultaneous colonic resection. The AUROC for the development and validation cohorts were 0.803 and 0.905, respectively (p < 0.0001). Youden's index suggested the cut-off score of - 95.9, with a sensitivity of 87.6% and a specificity of 62.9%. Male sex, low preoperative albumin, anaemia, laparoscopic conversion and simultaneous colonic resection were associated with an increased likelihood of requiring a stoma and were used to develop an SS. The calculator is available online at https://rebrand.ly/CrohnsStoma .

Perioperative outcomes of minimally invasive ileocolic resection for complicated Crohn disease: Results from a referral center retrospective cohort

BackgroundMinimally invasive ileocolic resection for complicated Crohn disease, defined as penetrating Crohn disease associated with intra-abdominal fistula, abscess, or phlegmon, is challenging. In addition, the impact of the minimally invasive approach on postoperative outcomes is still debated. This study aimed to compare the intraoperative and postoperative outcomes of minimally invasive ileocolic resection for complicated versus uncomplicated Crohn disease. MethodsA retrospective analysis of all consecutive adult patients with Crohn disease undergoing minimally invasive ileocolic resection from 2014 to 2021 was performed. Perioperative outcomes were compared between patients with complicated Crohn disease (complicated group) and patients without these lesions (uncomplicated group). ResultsAmong the 274 patients undergoing minimally invasive ileocolic resection for Crohn disease, 101 (36.9%) had a robotic approach, and 84 (30.7%) had complicated Crohn disease. Complicated patients were more frequently malnourished (32.1% vs 16.1%, P = .004) and had more frequent previous bowel resections for Crohn disease (22.1% vs 9.5%, P = .002). There were no differences between both groups regarding intraoperative complications (1.1% uncomplicated group vs 2.4% complicated group, P = .463), conversion rate (2.6% uncomplicated group vs 4.8% complicated group, P = .463), postoperative morbidity (27.4% uncomplicated group vs 34.5% complicated group, P = .231), intra-abdominal septic complications (4.2% uncomplicated group vs 7.1% complicated group, P = .309), and length of stay (3.8 ± 2.0 days uncomplicated group vs 4.2 ± 3.0 complicated group, P = .188). ConclusionMinimally invasive ileocolic resection for complicated Crohn disease is safe and feasible. Future prospective studies are needed to confirm these results.

Ileocolic Resection for Crohn Disease: The Influence of Different Surgical Techniques on Perioperative Outcomes, Recurrence Rates, and Endoscopic Surveillance.

Ileocolic resection (ICR) is the most common surgical procedure in Crohn disease (CD). There are many surgical techniques for performing ICRs and subsequent anastomoses. Recurrence of CD after ICR is common, often clinically silent, and thus requires monitoring including periodic use of endoscopy to detect early active disease. There is emerging evidence that surgical approaches may influence CD recurrence. This review explores the various surgical considerations, the data behind each decision, and how these techniques influence subsequent endoscopic surveillance.

A scoring system to predict a prolonged length of stay after surgery for Crohn's disease.

Many factors influence the postoperative length of stay (LOS) in Crohn's disease (CD). This study aims to identify the factors associated with a prolonged LOS after ileocolic resection (ICR) for CD and to develop a scoring system to predict the postoperative LOS in CD. Patient data were collected from St Marks Hospital, London, UK, and the Humanitas Clinical and Research Center Milan, Italy, for all patients who underwent an ICR for CD from 2005 to 2017. Logistic regression was used for multivariate analysis. The scoring system was developed from the logistic regression model. The performance of the scoring system was evaluated using the area under the receiver operating characteristic curve (AUROC). A total of 628 surgeries were included in the analysis. Eighty eight surgeries were excluded due to missing data. The remaining 543 were divided into two cohorts for the development (n=418) and validation (n=125) of the scoring system. The regression model was statistically significant (p<0.0001). The statistically significant independent variables included the time since diagnosis, American Society of Anesthesiologists (ASA) grade, perioperative use of steroids, surgical access, strictureplasty and platelet count. The AUROCs for the development and validation cohorts were 0.732 and 0.7, respectively (p<0.0001). The cut-off score suggested by Youden's index was 50, with a sensitivity of 65.6% and a specificity of 73.3%. The time since diagnosis, ASA grade, steroid use, surgical access, strictureplasty and platelet count were associated with a prolonged LOS and were used to develop a scoring system. The calculator is available online at https://rebrand.ly/Crohnscal.

P015 ILEOCOLIC RESECTION FOR CROHN’S DISEASE: CURRENT TRENDS FROM ANALYSIS OF 2 YEARS OF NSQIP IBD COLLABORATIVE DATA

Ileocolic resection (ICR) is performed for Crohn's disease (CD) patients with terminal ileitis requiring surgery. Current National Surgical Quality Improvement Program (NSQIP) data is lacking specificity around IBD surgery, including stoma formation and biologic therapies. The NSQIP IBD Collaborative (NSQIP-IBD) is a multicenter working group formed to better collect and analyze perioperative data unique to IBD patients under the auspices of NSQIP. We present retrospective analysis of a multicenter cohort of ICR for CD to describe the current practice of ICR for CD across our collaborative and explore factors associated with rates of postoperative complications on behalf of NSQIP-IBD.

Su1384 Medical Prophylaxis After Ileocolic Resection for Crohn's Disease – No Need to Rush

Background: Crohn's disease (CD) most commonly affects the terminal ileum, with a majority of patients ultimately requiring ileocolic resection. Histologic and immunologic evidence suggests that mucosal inflammation occurs early after exposure of the neoterminal ileum to autologous luminal contents. Therefore, early medical prophylaxis has been advocated to prevent endoscopic recurrence of CD. The purpose of this study was to evaluate whether the timing of medical prophylaxis after ileocolic resection affects endoscopic recurrence of CD. Methods: A single institution, prospectively maintained database was queried for CD patients undergoing ileocolic resection over a 13-year period ending January 2013. Patients were included if they underwent postoperative endoscopy within 12-months of surgery and were started on medical therapy using 5-aminosalicylates (5ASA), immunomodulators, or biologic agents prior to their first postoperative endoscopy. Patients were divided into two groups; those started on medical prophylaxis within 4 weeks of surgery (Early) and those who receivedmedical prophylaxis 4 weeks or more after surgery (Late). The primary endpoint was endoscopic recurrence (defined as a Rutgeerts' endoscopic score of i2, i3, or i4 at first postoperative endoscopy). Secondary endpoints included time to endoscopic recurrence, and any radiological, clinical and surgical recurrence. Results: The 165 study patients had a mean age (SD) of 32.2 (14.6) years and 91 (55%) were male (Table). Mean time to starting medical therapy was 3.8 (2) weeks. 99 patients (60%) were in the Early prophylaxis group and 65 (40%) were in the Late prophylaxis group. Compared to the Early prophylaxis group, the Late prophylaxis group was treated more commonly with biologics (p<0.001) and less commonly with 5-ASA (p=0.007) or immunomodulators (p=0.004). At a mean endoscopy time of 6.8 (2.4) months, 65 patients (39%) had endoscopic recurrence; 39 (39%) in the Early group and 26 (39%) in the Late group. There was also no significant difference in clinical or surgical recurrence between the Early versus Late prophylaxis patient groups. Subgroups analysis of patients treated postoperatively with non-biologic medical prophylaxis, biologic alone, or biologic with other agents, showed no significant difference in endoscopic recurrence between Early and Late prophylaxis patient groups. Conclusion: Althoughmedical prophylaxis after ileocolic resection for CD has been shown to reduce endoscopic recurrence, it may be safe to wait until patients are out of the initial perioperative period prior to initiating medical prophylaxis without any adverse effects on endoscopic recurrence.

Stapled Side-to-Side Anastomosis Might Be Better Than Handsewn End-to-End Anastomosis in Ileocolic Resection for Crohn’s Disease: A Meta-Analysis

Ileocolic anastomosis is an essential step in the treatment to restore continuity of the gastrointestinal tract following ileocolic resection in patients with Crohn's disease (CD). However, the association between anastomotic type and surgical outcome is controversial. The aim of this meta-analysis is to compare surgical outcomes between stapled side-to-side anastomosis (SSSA) and handsewn end-to-end anastomosis (HEEA) after ileocolic resection in patients with CD. Studies comparing SSSA with HEEA after ileocolic resection in patients with CD were identified in PubMed and EMBASE. Outcomes such as complication, recurrence, and re-operation were evaluated. Eight studies (three randomized controlled trials, one prospective non-randomized trial, and four non-randomized retrospective trials) comparing SSSA (396 cases) and HEEA (425 cases) were included. As compared with HEEA, SSSA was superior in terms of overall postoperative complications [odds ratio (OR), 0.54; 95 % confidence interval (CI) 0.32-0.93], anastomotic leak (OR 0.45; 95 % CI 0.20-1.00), recurrence (OR 0.20; 95 % CI 0.07-0.55), and re-operation for recurrence (OR 0.18; 95 % CI 0.07-0.45). Postoperative hospital stay, mortality, and complications other than anastomotic leak were comparable. Based on the results of our meta-analysis, SSSA would appear to be the preferred procedure after ileocolic resection for CD, with reduced overall postoperative complications, especially anastomotic leak, and a decreased recurrence and re-operation rate.

Laparoscopic‐Assisted Versus Open Ileocolic Resection for Adolescent Crohn Disease

ABSTRACTBackgroundLaparoscopic‐assisted ileocolic resection for Crohn disease has been reported as an acceptable alternative to the open procedure in adults. We evaluated our experience with this procedure in the adolescent population.MethodsAll adolescents undergoing ileocolic resection for Crohn disease during a 3‐year period were retrospectively reviewed. Intraoperative and early postoperative results were analyzed, comparing those undergoing the laparoscopic‐assisted approach with those having open resection.ResultsEleven patients (mean age, 15.6 years) underwent open and 12 patients (mean age, 16.5 years) underwent laparoscopic‐assisted resection. None had undergone previous resection. The two groups did not differ with respect to time from diagnosis to surgery, indications for surgery, preoperative medical therapy, operative time, or length of intestine resected. One patient in the laparoscopic‐assisted group was converted to an open procedure. There were no intraoperative complications in either group. Although no statistically significant differences were noted for number of days on narcotic, total dosage of narcotic, and time to regular diet, patients undergoing laparoscopic‐assisted resection were discharged 2.2 days earlier (5.4 vs. 7.6;P &lt; 0.05). There was one wound infection and one intraabdominal abscess in the open resection group, and a single patient in the laparoscopic‐assisted group with postoperative fever and a wound infection.ConclusionsLaparoscopic‐assisted ileocolic resection is a safe alternative to open surgery in adolescent patients with Crohn disease.

Laparoscopic-assisted versus open ileocolic resection for adolescent Crohn disease.

Laparoscopic-assisted ileocolic resection for Crohn disease has been reported as an acceptable alternative to the open procedure in adults. We evaluated our experience with this procedure in the adolescent population. All adolescents undergoing ileocolic resection for Crohn disease during a 3-year period were retrospectively reviewed. Intraoperative and early postoperative results were analyzed, comparing those undergoing the laparoscopic-assisted approach with those having open resection. Eleven patients (mean age, 15.6 years) underwent open and 12 patients (mean age, 16.5 years) underwent laparoscopic-assisted resection. None had undergone previous resection. The two groups did not differ with respect to time from diagnosis to surgery, indications for surgery, preoperative medical therapy, operative time, or length of intestine resected. One patient in the laparoscopic-assisted group was converted to an open procedure. There were no intraoperative complications in either group. Although no statistically significant differences were noted for number of days on narcotic, total dosage of narcotic, and time to regular diet, patients undergoing laparoscopic-assisted resection were discharged 2.2 days earlier (5.4 vs. 7.6; P < 0.05). There was one wound infection and one intraabdominal abscess in the open resection group, and a single patient in the laparoscopic-assisted group with postoperative fever and a wound infection. Laparoscopic-assisted ileocolic resection is a safe alternative to open surgery in adolescent patients with Crohn disease.

Risk Factors of Complications After Ileocolic Resection for Crohn Disease According to the Comprehensive Complication Index

Risk Factors of Complications After Ileocolic Resection for Crohn Disease According to the Comprehensive Complication Index