Open versus minimally invasive small bowel resection for Crohn’s disease: a NSQIP retrospective review and analysis

Horsey, Michael L.; Lai, Debra; Herur-Raman, Aalap; Amdur, Richard L.; Chandler, Matthew; Ng, Matthew; Obias, Vincent

doi:10.1007/s00464-021-08927-8

Cited by 5 publications

(6 citation statements)

References 27 publications

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“…This may be due to the open assisted approach of extracorporeal Kono‐S anastomosis, although differences between countries and local protocols in hospitalization make it difficult to draw definitive conclusions. A minimally invasive approach in CD has been previously suggested to result in a shorter hospital stay compared with an open approach [27]. Celentano et al.…”

Section: Discussionmentioning

confidence: 99%

“…This may be due to the open assisted approach of extracorporeal Kono-S anastomosis, although differences between countries and local protocols in hospitalization make it difficult to draw definitive conclusions. A minimally invasive approach in CD has been previously suggested to result in a shorter hospital stay compared with an open approach[27]. Celentano et al[28] also report older age, American Society of Anesthesiologists (ASA) grade ≥3 or administration of preoperative total parental nutrition (TPN) as risk factors for prolonged hospitalization.…”

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confidence: 99%

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A new surgical technique: robotic intracorporeal Kono‐S anastomosis in Crohn's – a safety and feasibility case series on short‐term outcomes

Smalbroek,

Poelmann,

Smits

2024

Colorectal Disease

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AimThe Kono‐S anastomosis was introduced as a possible solution to the high surgical recurrence rates in Crohn's disease. However, this technique is known to be challenging, which is why it was originally performed in an extracorporeal setting. The aim of this case series was to assess safety, in terms of intra‐/postoperative complications, and feasibility, in terms of successful performance of anastomosis, of a robot‐assisted intracorporeal Kono‐S anastomosis.MethodThis is a prospective single‐centre consecutive case series. Patients were considered eligible if they were diagnosed with refractory Crohn's disease with significant bowel stenosis of the terminal ileum. All patients underwent robot‐assisted intracorporeal Kono‐S anastomosis. Perioperative care was provided according to the Enhanced Recovery After Surgery® protocol. Follow‐up for postoperative complications was 30 days.ResultsTwenty patients were included, of whom 11 (55%) were men. The median age was 30 years [interquartile range (IQR) 22–51 years] and the median BMI was 25 kg/m2 (IQR 19–28 kg/m2). Intracorporeal Kono‐S anastomosis was successfully performed in all cases. The median operating time was 155 min (IQR 144–176 min) and the median length of stay was 3 days (IQR 1–5 days). No conversions or 30‐day mortality were observed. One patient experienced anastomotic leakage, which was treated with radiologically guided drainage. A total of three patients experienced postoperative complications in the first 30 days.ConclusionPerformance of intracorporeal robot‐assisted Kono‐S anastomosis seems safe and feasible in this case series for Crohn's disease. Since this is a first case series, further research is required to confirm results in a larger population‐based cohort.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A new surgical technique: robotic intracorporeal Kono‐S anastomosis in Crohn's – a safety and feasibility case series on short‐term outcomes

Smalbroek,

Poelmann,

Smits

2024

Colorectal Disease

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“…[120][121][122] For small bowel resection, a retrospective review revealed that laparoscopic surgery is associated with an equivalent or improved morbidity over open surgery in select patients with small bowel CD. 123 In summary, retrospective studies and randomized studies have indicated that laparoscopic approaches for patients with CD are both safe and feasible. The choice of laparoscopic or open approaches depends on patient factors, surgeon preference, and equipment availability.…”

Section: Laparoscopic Surgery In CDmentioning

confidence: 99%

“…Even in recurrent complicated cases, several studies have reported that laparoscopic ileocolic resection can be performed in carefully selected patients and has comparable outcomes to primary laparoscopic resection 120–122 . For small bowel resection, a retrospective review revealed that laparoscopic surgery is associated with an equivalent or improved morbidity over open surgery in select patients with small bowel CD 123 …”

Section: Advances In Operative Proceduresmentioning

confidence: 99%

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Perioperative optimization of Crohn's disease

Lin

Chen

et al. 2022

Annals of Gastroent Surgery

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Crohn's disease (CD) is a chronic inflammatory disease mainly affecting the gastrointestinal tract. With the increased availability of modalities in the last two decades, the treatment of CD has advanced remarkably. Although medical treatment is the mainstay of therapy, most patients require surgery during the course of their illness, especially those who experience complications. Nutritional optimization and ERAS implementation are crucial for patients with CD who require surgical intervention to reduce postoperative complications. The increased surgical risk was found to be associated with the use of corticosteroids, but the association of surgical risk with immunomodulators, biologic therapy, such as anti‐TNF mediations, anti‐integrin medications, and anti‐IL 12/23 was low in certainty. Decisions about preoperative medication must be made on an individual case‐dependent basis. Preoperative imaging studies can assist in the planning of appropriate surgical strategies and approaches. However, patients must be informed of any alterations to their treatment. In summary, the management of perioperative medications and surgery‐related decision‐making should be individualized and patient‐centered based on a multidisciplinary approach.

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Comparison of outcomes in small bowel surgery for Crohn’s disease: a retrospective NSQIP review

Aras,

Patel,

Satchell

et al. 2024

Int J Colorectal Dis

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Introduction Despite advances in medical therapy, approximately 33% of Crohn’s disease (CD) patients will need surgery within 5 years after initial diagnosis. Several surgical approaches to CD have been proposed including small bowel resection, strictureplasty, and combined surgery with resection plus strictureplasty. Here, we utilize the American College of Surgeons (ACS) national surgical quality registry (NSQIP) to perform a comprehensive analysis of 30-day outcomes between these three surgical approaches for CD. Methods The authors queried the ACS-NSQIP database between 2015 and 2020 for all patients undergoing open or laparoscopic resection of small bowel or strictureplasty for CD using CPT and IC-CM 10. Outcomes of interest included length of stay, discharge disposition, wound complications, 30-day related readmission, and reoperation. Results A total of 2578 patients were identified; 87% of patients underwent small bowel resection, 5% resection with strictureplasty, and 8% strictureplasty alone. Resection plus strictureplasty (combined surgery) was associated with the longest operative time (p = 0.002). Patients undergoing small bowel resection had the longest length of hospital stay (p = 0.030) and the highest incidence of superficial/deep wound infection (44%, p = 0.003) as well as the highest incidence of sepsis (3.5%, p = 0.03). Small bowel resection was found to be associated with higher odds of wound complication compared to combined surgery (OR 2.09, p = 0.024) and strictureplasty (1.9, p = 0.005). Conclusion Our study shows that various surgical approaches for CD are associated with comparable outcomes in 30-day related reoperation and readmission, or disposition following surgery between all three surgical approaches. However, small bowel resection displayed higher odds of developing post-operative wound complications.

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Open versus minimally invasive small bowel resection for Crohn’s disease: a NSQIP retrospective review and analysis

Cited by 5 publications

References 27 publications

A new surgical technique: robotic intracorporeal Kono‐S anastomosis in Crohn's – a safety and feasibility case series on short‐term outcomes

A new surgical technique: robotic intracorporeal Kono‐S anastomosis in Crohn's – a safety and feasibility case series on short‐term outcomes

Perioperative optimization of Crohn's disease

Comparison of outcomes in small bowel surgery for Crohn’s disease: a retrospective NSQIP review

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