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

Pellino, Gianluca; Keller, Deborah S.; Sampietro, Gianluca; Angriman, Imerio; Carvello, Michele; Celentano, Valerio; Colombo, Francesco; Candido, Francesca Di; Laureti, Silvio; Luglio, Gaetano; Poggioli, Gilberto; Rottoli, Matteo; Scaringi, Stefano; Sciaudone, Guido; Sica, Giuseppe; Sofo, Luigi; Leone, Salvatore; Danese, Silvio; Spinelli, Antonino; Delaini, Gian Gaetano; Selvaggi, Francesco

doi:10.1007/s10151-020-02183-z

Cited by 41 publications

(23 citation statements)

References 309 publications

(392 reference statements)

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“…Of the 16 hospitals performing at least one procedure between completion proctectomy and proctocolectomy, only four (25%) performed at least three procedures per year, which could also reflect on the difficulties for surgeons in training to accumulate exposure to these complex procedures [17]. To reduce this variability, the SICCR recently published a national position statement with the aim to standardise multidisciplinary management and surgical treatment of CD nationally [18], and [19], the American Society of Colorectal Surgery-ASCRS) [20]. A general aim of guidelines is to reduce variations in practice, by providing evidence based guidance on the best treatment options, with the aim to enhance patients' outcomes.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Celentano¹,

Pellino²,

Rottoli³

et al. 2020

Langenbecks Arch Surg

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Aim The different surgical options for patients with colonic Crohn’s disease (CD) include segmental colectomy, subtotal colectomy or proctocolectomy with end ileostomy. We present a national, multicentre study, promoted by the Italian Society of Colorectal Surgery with the aim to collect benchmark data and national variations on multidisciplinary management and postoperative outcomes of patients undergoing surgery for colonic CD. Methods All adult patients having elective surgery for colonic CD from June 2018 to May 2019 were eligible for participation in this retrospective study. The primary outcome measure was postoperative morbidity within 30 days of surgery. Results One hundred twenty-two patients were included: 55 subtotal colectomy, 30 segmental colectomy, 25 proctectomy and 12 proctocolectomy. Eighty-six patients (70.4%) were discussed at the inflammatory bowel disease (IBD) multidisciplinary team meeting (MDT) prior to surgery. This ranged from 76.6% for segmental colectomy to 60% for subtotal colectomy, 66.6% for proctocolectomy and 48% for proctectomy. The proportion of patients counselled by a stoma nurse preoperatively was 50%. Laparoscopy was associated with reduced postoperative morbidity (p = 0.017) and shorter length of hospital stay (p < 0.001), whilst pre-operative anti-TNF was associated with Dindo-Clavien ≥ 3 complications (p = 0.023) and longer in-hospital stay (p = 0.007). The main procedure performed (segmental colectomy, subtotal colectomy, proctocolectomy or proctectomy) was not associated with postoperative morbidity (p = 0.626). Conclusions Surgery for colonic CD has a high rate of postoperative complications. Almost a third of the patients were not preoperatively discussed at the IBD MDT, whilst the use of minimally invasive surgery for surgical treatment of colonic CD ranges from 40 to 66%.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Celentano¹,

Pellino²,

Rottoli³

et al. 2020

Langenbecks Arch Surg

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“…Multiple imaging modalities are often required to assess severity and extent of Crohn’s disease (CD), considering its multifocal and relapsing nature, with magnetic resonance imaging (MRI) representing the preferred technique to aid surgical decision making in view of the high sensitivity for detection of proximal lesions and preoperative mapping [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of intraoperative ultrasound of the small bowel during Crohn’s disease surgery

et al. 2020

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Background Intraoperative assessment of the extent and location of Crohn's disease is not standardised and relies on a mixture of surgeons' experience, tactile feedback and macroscopic appearance. To overcome this variability, we developed a protocol for full intraoperative ultrasound scan of the small bowel and we here report the results of "Assessing the Feasibility and Safety of Using Intraoperative Ultrasound in Ileocolic Crohn's Disease-The IUSS CROHN Study". Methods This is a prospective single centre observational study with enrolment of all patients undergoing elective surgery for terminal ileal Crohn's disease from January 2019 to March 2020. Patients underwent laparoscopic ileocolic resection, according to a standardised technique. Ultrasound intraoperative quantitative assessment was performed according to the METRIC (MREnterography or ulTRasound in Crohn's disease) scoring guide. Results Intraoperative ultrasound was successfully performed in 6 patients from the ileocaecal valve to the proximal jejunum. The median time required was 23.5 min (range 17-37 min) as compared to 6.5 min (5-12 min) required for the macroscopic evaluation performed by the surgeon. In 3 patients, intraoperative ultrasound identified more disease than surgical evaluation. Conclusions This feasibility study demonstrated the safety of intraoperative ultrasound and allowed the development of a standardised protocol for intraoperative ultrasound and the data collection required to inform a randomised multicentre study.

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“…It’s of paramount importance to not continue with the dissection beyond the promontory of the sacrum. In fact, a pelvic dissection in acute IBD patients is strongly discouraged, and leaving an adequate rectal stump, with the intact sacral plane, is the basis for a safe completion proctectomy and ileo-anal-pouch anastomosis (as reported by European and Italian surgical Guidelines) [ 1 , 2 , 3 , 4 ]. The colon is finally divided at the recto-sigmoid junction by an endo-stapling device.…”

Section: Methodsmentioning

confidence: 99%

“…With traction of the ileocecal region, the ileocolic pedicle can be seen bowstringing through the mesentery. If no suspicion of colorectal cancer is present, the ileocolic vessels should be preserved, in accordance with European and Italian surgical guidelines, in case of necessity of mesenteric lengthening at the time of ileo-pouch-anal anastomosis [ 1 , 2 , 3 , 4 ]. Critical-view IX: Ileocolic vessels, the superior margin in case of preservation, inferior and superior margins for control and division.…”

Section: Methodsmentioning

confidence: 99%

“…Subtotal colectomy (SCo), in an urgent or emergency setting, is the treatment of choice for severe acute colitis in Inflammatory Bowel Disease (IBD) patients after failure of medical therapy [ 1 , 2 , 3 , 4 ]. The laparoscopic approach has been proposed based on several short- and long-term advantages, such as less perioperative complications, short recovery and hospital discharge, fewer adhesions and incisional hernias, enhanced body image, and preservation of fecundity in female patients.…”

Section: Introductionmentioning

confidence: 99%

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Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis

Sampietro¹,

Colombo

Corsi

2020

JCM

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Acute severe colitis is the major indication for surgery in inflammatory bowel diseases (IBD), and in particular, in ulcerative colitis (UC). A laparoscopic approach for abdominal colectomy is recommended, due to better perioperative and long-term outcomes. However, costs, time-spending, and outcomes are still a topic of improvement. We designed a standardized 10-steps, sequential approach to laparoscopic colectomy, based on the philosophy of the “critical view of safety”, with the aim to improve perioperative outcomes (operative duration, estimated blood loss, complications, readmissions, reoperations, and length of postoperative stay). We performed a retrospective cohort study using data from a prospectively maintained clinical database. We included all the consecutive, unselected patients undergoing laparoscopic subtotal colectomy (SCo) for IBD between 2008 and 2019 in a tertiary IBD Italian Centre. Starting from 2015, we regularly adopted the novel Sequential Approach for a Critical-View Colectomy (SACCo) technique. We included 59 (40.6%) patients treated with different laparoscopic approaches, and 86 patients (59.4%) operated on by the SACCo procedure. The mean operating time was significantly shorter for the SACCo group (144 vs. 224 min; p < 0.0001). The SACCo technique presented a trend to fewer major complications (6.8% vs. 8.3%), less readmissions (2.3% vs. 13.5%; p = 0.01), and shorter postoperative hospital stay (7.2 vs. 8.8 days; p = 0.003). Laparoscopic SACCo-technique is a safe and reproducible surgical approach for acute severe colitis and may improve the outcomes of this demanding procedure.

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

Cited by 41 publications

References 309 publications

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Surgical treatment of colonic Crohn’s disease: a national snapshot study

Feasibility of intraoperative ultrasound of the small bowel during Crohn’s disease surgery

Sequential Approach for a Critical-View COlectomy (SACCO): A Laparoscopic Technique to Reduce Operative Time and Complications in IBD Acute Severe Colitis

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