A systematic review of segmental <i>vs</i> subtotal colectomy and subtotal colectomy <i>vs</i> total proctocolectomy for colonic Crohn's disease

Angriman, Imerio; Pirozzolo, Giovanni; Bardini, Romeo; Cavallin, Francesco; Castoro, Carlo; Scarpa, Marco

doi:10.1111/codi.13769

Cited by 43 publications

(21 citation statements)

References 32 publications

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“…In case of technical failure surgical segmental resection is suggested. Although there is a greater risk of recurrence than after more extensive resection, it guarantees a lower risk of permanent stoma as reported in a systematic review [178]. There are no data concerning biologic treatment after segmental colectomies.…”

Section: Item 26mentioning

confidence: 99%

“…If the rectum is not involved, an ileorectal anastomosis is a safe option (EL2) [Agreement: "Agree" 87.50%, "Partially agree" 6.25%, "Disagree" 6.25%, round I] Item 28 Endoscopic surveillance is mandatory due to the risk of developing cancer in the rectal stump (EL2) [Agreement: "Agree" 93.75%, "Partially agree" 6.25%, round I] Crohn's colitis unresponsive to medical treatment often requires a subtotal colectomy. Colectomy has been shown to be associated with a lower rate of recurrence than segmental resections [178,182].…”

Section: Fate Of the Rectummentioning

confidence: 99%

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Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn’s disease

et al. 2020

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The Italian Society of Colorectal Surgery (SICCR) promoted the project reported here, which consists of a position statement of Italian colorectal surgeons to address the surgical aspects of Crohn's disease management. Members of the society were invited to express their opinions on several items proposed by the writing committee, based on evidence available in the literature. The results are presented, focusing on relevant points. The present paper is not an alternative to available guidelines; rather, it offers a snapshot of the attitudes of SICCR surgeons about the surgical treatment of Crohn's disease. The committee was able to identify some points of major disagreement and suggested strategies to improve quality of available data and acceptance of guidelines.

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Section: Item 26mentioning

confidence: 99%

Section: Fate Of the Rectummentioning

confidence: 99%

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn’s disease

et al. 2020

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“…However, with regard to postoperative complications, the analysis favors IRA (OR: 0.19, 95% CI: 0.09-0.38, p < 0.0001). 54 These data suggest that IRA is a feasible option for maintaining intestinal continuity among patients with colonic CD and relative rectal sparing as long as the patient can accept increased risks of disease recurrence and need for further operative intervention.…”

Section: Ileorectal Anastomosismentioning

confidence: 83%

“…51 However, these benefits come with an increased risk of perineal wound complications, the possibility of damage to the pelvic autonomic nerves controlling urinary continence and sexual function, and the need for a permanent ileostomy. [52][53][54] Patients and surgeons alike have strong inclinations to maintain bowel continuity. As such, many have sought more conservative options.…”

Section: Ileorectal Anastomosismentioning

confidence: 99%

Is There a Role for Ileal Pouch Anal Anastomosis in Crohn's Disease?

Lopez

Zaghyian

Fleshner

2019

Clinics in Colon and Rectal Surgery

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Traditionally, surgical interventions for colonic Crohn's disease (CD) have been limited to total abdominal colectomy and ileorectal anastomosis, or total proctocolectomy with end ileostomy if there is rectal involvement. However, improved understandings of the biology of CD, as well as the development of biologic therapies, have enabled more limited resections. Here, we review the indications for, and limitations of, specific procedures aiming to preserve intestinal continuity in colonic CD.

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“…Less radical options potentially reduce complications and may avoid a stoma but at the expense of higher recurrence and the potential for further surgery. A recent meta‐analysis concluded that segmental, subtotal and proctocolectomy were equally effective treatment options for patients with colonic Crohn's disease and the choice of operation remains fundamentally dependent on the extent of colonic disease. A lower recurrence rate with panproctocolectomy was confirmed and segmental colectomy had the highest risk of postoperative complications.…”

Section: Proctectomy and Proctocolectomymentioning

confidence: 99%

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

et al. 2018

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Aim There is a requirement of an expansive and up to date review of surgical management of inflammatory bowel disease (IBD) that can dovetail with the medical guidelines produced by the British Society of Gastroenterology. Methods Surgeons who are members of the ACPGBI with a recognised interest in IBD were invited to contribute various sections of the guidelines. They were directed to produce a procedure based document using literature searches that were systematic, comprehensible, transparent and reproducible. Levels of evidence were graded. An editorial board was convened to ensure consistency of style, presentation and quality. Each author was asked to provide a set of recommendations which were evidence based and unambiguous. These recommendations were submitted to the whole guideline group and scored. They were then refined and submitted to a second vote. Only those that achieved >80% consensus at level 5 (strongly agree) or level 4 (agree) after 2 votes were included in the guidelines. Results All aspects of surgical care for IBD have been included along with 157 recommendations for management. Conclusion These guidelines provide an up to date and evidence based summary of the current surgical knowledge in the management of IBD and will serve as a useful practical text for clinicians performing this type of surgery.

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A systematic review of segmental vs subtotal colectomy and subtotal colectomy vs total proctocolectomy for colonic Crohn's disease

Cited by 43 publications

References 32 publications

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn’s disease

Inflammatory bowel disease position statement of the Italian Society of Colorectal Surgery (SICCR): Crohn’s disease

Is There a Role for Ileal Pouch Anal Anastomosis in Crohn's Disease?

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

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