A systematic review of pre, peri and postoperative factors and their implications for the lengths of resected bowel segments in patients with Crohn’s disease

Abstract

Aim Several pre, peri and postoperative factors may have implications for the lengths of resected small bowel segments in Crohn’s disease patients. It might also affect patient outcome. We reviewed the current literature on factors and their implications for the lengths of resected small bowel segments and possible correlations with postoperative outcome. Method Searches were independently engineered by the authors and a research-librarian in MEDLINE and OVID databases using PubMed and EMBASE engines in compliance with PRISMA recommendations. All original articles, reviews and guidelines published in the period of 1985–2016 with last search date 13th of February 2016 on bowel resection in Crohn’s disease patients were assessed for inclusion. Results We identified 52 studies for synthesis. Preoperative: Perforation as indication for surgery and increased visceral obesity may be factors resulting in longer lengths of resected small bowel segments. Administration of total parenteral nutrition might reduce resection lengths. Perioperative: No difference in resection lengths in elective versus acute surgery, laparoscopic versus open approaches or in case of intra-operative blood transfusions. Stapled anastomoses might conserve more bowel than sutured ones. Postoperative: The lengths of the resected small bowel segments most likely have no impact on recurrence rates. Conclusion No pre, peri or postoperative factors were found to have definitive implications for the lengths of resected small bowel segments. Correlation between the lengths of resection and recurrence is weak. Highlights

Patients with Crohn’s disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications’ rate

“…In contrast, central ligation of blood vessels and lymph nodes harvest are less important for patients with CD. The disease-free resection margin might influence recurrence rate[14,15].…”