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Duan M, Coffey JC, Li Y. Mesenteric-based surgery for Crohn's disease: evidence and perspectives. Surgery 2024; 176:51-59. [PMID: 38594102 DOI: 10.1016/j.surg.2024.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/20/2024] [Accepted: 02/26/2024] [Indexed: 04/11/2024]
Abstract
Postoperative anastomotic recurrence of Crohn's disease is challenging and can lead to symptom recurrence and further surgery. The mesenteric pole of the intestine is the initial site of macroscopic anastomotic recurrence, and the mesentery may play an important role in recurrence after surgical resection. Therefore, "mesenteric-based surgery" has gained increasing attention by clinicians. However, the role of mesentery in the postoperative recurrence remains controversial. This review will examine mesenteric changes in Crohn's disease, proposed roles for mesentery in disease progression, and the potential for mesenteric-based surgery in the surgical management of Crohn disease.
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Affiliation(s)
- Ming Duan
- Center for Inflammatory Bowel Diseases, Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, China
| | - J Calvin Coffey
- Department of Surgery, University of Limerick Hospital Group, and School of Medicine, University of Limerick, Limerick, Ireland.
| | - Yi Li
- Center for Inflammatory Bowel Diseases, Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, China
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Ng ZQ, Mackenzie S, Gilmore A, Diab J, Gibson K. Proposed clinical operative synoptic report for ileocolic resection for Crohn's disease. ANZ J Surg 2024; 94:917-922. [PMID: 38174661 DOI: 10.1111/ans.18854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Crohn's disease patients may require multiple surgeries during their lifetime. Because operative reports are not standardized, information relevant to future management may not be documented. Synoptic reports used in other fields such as histopathology have proven to be effective and allow consistent documentation of results. The aim of this study was to retrospectively review the completeness of the operative reports for ileocolic Crohn's resections (ICR) and to propose a synoptic report. METHODS A draft synoptic operative report for ICR for Crohn's disease was presented in the IBD multidisciplinary meeting and a Delphi process used to gain consensus for inclusion in the synoptic report. Retrospective analysis of consecutive ICR from January 2010 to April 2023 was undertaken to determine the presence of the standardized criteria. RESULTS A total of 66 ICR were performed in 63 patients during the study period. No operation reports were excluded. The examination of bowel for macroscopic disease was partially documented in 88% cases. The extent of mesenteric resection and any difficulty encountered during dissection were poorly documented. The remaining length of small and large intestines was not documented in most operative reports. The clinical sections that were compulsory entrance in the electronic operative report achieved 100% compliance. CONCLUSION This study has demonstrated that key information was often deficient in the operative report. This may have a significant impact on the future management of Crohn's patients and affects the interpretation of research outcomes. A proposed clinical synoptic operative report is easy to use and ensures compliance.
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Affiliation(s)
- Zi Qin Ng
- Department of Colon and Rectal Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Scott Mackenzie
- Department of Colon and Rectal Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Andrew Gilmore
- Department of Colon and Rectal Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
- Macquarie University Hospital, Macquarie Park, New South Wales, Australia
| | - Jason Diab
- Department of Colon and Rectal Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
- School of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Katherine Gibson
- Department of Colon and Rectal Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
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van der Does de Willebois EML, Duijvestein M, Wasmann KA, D'Haens GRAM, van der Bilt JDW, Mundt MW, Hompes R, van der Vlugt M, Buskens CJ, Bemelman WA. Endoscopic Recurrence or Anastomotic Wound Healing Phenomenon after Ileocolic Resection for Crohn's Disease: The Challenges of Accurate Endoscopic Scoring. J Crohns Colitis 2022; 17:693-699. [PMID: 36382539 PMCID: PMC10155740 DOI: 10.1093/ecco-jcc/jjac175] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Adequate endoscopic scoring in Crohn's disease (CD) is crucial, as dictates the need for initiating postoperative medical therapy and is utilized as outcome parameter in clinical trials. We aimed to observe anastomotic wound healing in relation to endoscopic scoring of both inverted and everted stapled lines in side-to-side anastomoses. METHODS Two prospective patient cohorts were included: ileocolic resection (ICR) for CD, and right-sided colon resection for colorectal cancer (CRC). Videos taken during colonoscopy six months postoperatively were evaluated. The SES-CD and modified Rutgeerts score were determined. Primary outcome was the presence of ulcerations in CD patients on both the inverted and everted stapled lines. Secondary outcomes were the presence of anastomotic ulcerations in CRC patients and the number of cases having ulcerations exclusively at the inverted stapled line. RESULTS Of the 82 patients included in the CD cohort, ulcerations were present in 63/82 (76·8%) at the inverted- versus 1/71 (1·4%) at the everted stapled line. Likewise in the CRC cohort, ulcerations were present in 4/6 (67·7%) at the inverted versus 0/6 (0%) at the everted stapled line. 27% of the 63 patients in the CD cohort had ulcerations exclusively on the inverted stapled line. CONCLUSION Inverted stapled lines heal with ulcerations, whereas the everted stapled line heal without any ulcerations, both in CD and non-CD patients. The abnormalities at the inverted stapled line might interfere with endoscopic scoring of recurrence, with potentially an impact on patients' quality of life and on health-care costs if postoperative treatment is initiated incorrectly.
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Affiliation(s)
- Eline M L van der Does de Willebois
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands.,Department of Gastroenterology, Radboudumc, Nijmegen, the Netherlands
| | - Karin A Wasmann
- Department of Surgery, UMC Utrecht, Utrecht, the Netherlands
| | - Geert R A M D'Haens
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.,Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | | | - Marco W Mundt
- Department of Gastroenterology, Flevoziekenhuis, Almere, the Netherlands
| | - Roel Hompes
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Manon van der Vlugt
- Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.,Department of Gastroenterology and Hepatology, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.,Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands.,IBD unit, IRCCS Ospedale San Raffaele, Milan, Italy
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Chen W, Zhou J, Chen M, Jiang C, Qian Q, Ding Z. Isoperistaltic side-to-side anastomosis for the surgical treatment of Crohn disease. Ann Surg Treat Res 2022; 103:53-61. [PMID: 35919111 PMCID: PMC9300438 DOI: 10.4174/astr.2022.103.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Wenhao Chen
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Junjie Zhou
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Min Chen
- Department of Gastroenterology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Congqing Jiang
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Qun Qian
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
| | - Zhao Ding
- Department of Colorectal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
- Inflammatory Bowel Diseases Center, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Key Laboratory of Intestinal & Colorectal Diseases, Quality Control Center of Colorectal Surgery, Health Commission of Hubei Province, Wuhan, China
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