Determining Predictors for Intra-abdominal Septic Complications Following Ileocolonic Resection for Crohn's Disease--Considerations in Pre-operative and Peri-operative Optimisation Techniques to Improve Outcome

Morar, Pritesh; Hodgkinson, J. D.; Thalayasingam, S.; Koysombat, Kanyada; Purcell, Martha; Hart, Ailsa; Warusavitarne, Janindra; Faiz, Omar

doi:10.1093/ecco-jcc/jjv051

Cited by 99 publications

(79 citation statements)

References 25 publications

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“…Exclusive enteral nutrition pre‐treatment and operation time were the only factors associated with post‐operative abscess, collection or anastomotic leak, with the use of EEN the only independent variable remaining on multivariable analysis. In contrast to previous studies, we did not demonstrate associations with smoking status, corticosteroids or anti‐TNF exposure and the occurrence of post‐operative abscess, collection or anastomotic leak.…”

Section: Discussioncontrasting

confidence: 99%

Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease

Heerasing

Thompson

Hendy

et al. 2017

Aliment Pharmacol Ther

111

140

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Exclusive enteral nutrition frequently down-stages the need for surgery in patients presenting with stricturing or penetrating complications of Crohn's disease; it is associated with a reduction in systemic inflammation, operative times and the incidence of post-operative abscess or anastomotic leak. Further trials are needed to elucidate how exclusive enteral nutrition may improve operative outcomes.

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Section: Discussioncontrasting

confidence: 99%

Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease

Heerasing

Thompson

Hendy

et al. 2017

Aliment Pharmacol Ther

111

140

View full text Add to dashboard Cite

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“…Standing alone, these anthropometric and laboratory parameters are not indicators of nutritional status in the presence of an active inflammatory syndrome, seeing they are highly influenced by variation in and retention of fluids [16, 49]. Preoperative serum albumin levels may reflect variations in a patient’s inflammatory status and/or nutritional state and, therefore, for one or both reasons, values below 3 g/dL are a risk factor for postoperative complications in abdominal surgery [4, 5, 7, 11, 16]. The inflammatory environment elicited by the disease and surgery actively contributes to a descent in serum albumin and perioperative undernutrition, the control of the former being determinant in the improvement of the latter two [63, 73, 74].…”

Section: Discussionmentioning

confidence: 99%

“…Intra-abdominal septic complications (IASCs) may reach 50%, the risk factors for which the literature mostly reports therapy with corticosteroids (CSTs), malnutrition, intra-abdominal abscesses, low serum albumin levels, and emergent surgery [6-11]. …”

Section: Introductionmentioning

confidence: 99%

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Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

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Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission – here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

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“…The influence of biological therapy on postoperative morbidity is now recognized. Although some studies [19][20][21][22][23] did not find any correlation between the use of infliximab and the occurrence of early septic complications after abdominal surgery for CD, several retrospective studies [24][25][26], meta-analyses [27][28][29] and a recent large, prospective, multi-institutional series [30] have reported a significant association between the preoperative use of biological therapy and postoperative intra-abdominal septic complications. In consideration of the deleterious effect on postoperative morbidity caused by biological therapy, refinement in surgical techniques may very well be needed to maintain or improve postoperative rates of morbidity.…”

Section: Discussionmentioning

confidence: 99%

Changing trends in surgery for abdominal Crohn's disease

et al. 2018

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Aim The introduction of biological agents and laparoscopy are, arguably, the most important developments for the treatment of Crohn's disease (CD) in the last two decades. Due to the efficacy of biological agents in treating mild disease, it is likely that the percentage of surgery for complex cases may have increased. The objective of this study was to analyse the changing characteristics and results of the surgical treatment of patients with CD over the past 13 years. Methods All patients who underwent abdominal surgery for CD between 2004 and 2016 were retrospectively identified. Data were compared between two periods (2004–2010 and 2011–2016). Results A total of 908 procedures were performed (48% men, mean age 43 ± 16 years). Demographic and CD characteristics changed significantly over time: comorbidities were more frequent (35% vs 46%, P < 0.0001), and preoperative steroids (28% vs 36%, P < 0.01) and anti‐tumour necrosis factor (20% vs 40%, P < 0.0001) treatments were more frequently used in the second period. Smoking (14% vs 8%, P < 0.0001) and use of immunosuppressors (32% vs 22%, P < 0.001) decreased significantly. More cases of penetrating disease (22% vs 32%, P < 0.001) were operated upon in the second period. The laparoscopic approach (49% vs 57%, P < 0.04) was more frequently performed and mean blood loss (167 ± 222 vs 123 ± 243 ml, P < 0.01) decreased significantly. Postoperative morbidity did not change between the two periods. Conclusion Despite a higher incidence of comorbidities and the use of biologics postoperative morbidity remained unchanged. An increased use of laparoscopy and a decreased intra‐operative blood loss may have contributed to offsetting the impact of increased comorbidity.

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Determining Predictors for Intra-abdominal Septic Complications Following Ileocolonic Resection for Crohn's Disease--Considerations in Pre-operative and Peri-operative Optimisation Techniques to Improve Outcome

Cited by 99 publications

References 25 publications

Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease

Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn's disease

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Changing trends in surgery for abdominal Crohn's disease

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