Surgical predictors of recurrence of Crohn’s disease after ileocolonic resection

Scarpa, Marco; Ruffolo, Cesare; Bertin, Eugenia; Polese, Lino; Filosa, Teresa; Prando, Daniela; Pagano, Domenico; Norberto, Lorenzo; Frego, Mauro; D’Amico, Davide; Angriman, Imerio

doi:10.1007/s00384-007-0329-4

Cited by 54 publications

(37 citation statements)

References 30 publications

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“…Although some authors denied any influence on the type of anastomosis, others have shown significantly lower Crohn's recurrence rates at stapled side-to-side anastomosis after ileocolonic resection compared with handsewn end-to-end anastomosis [23][24][25], perhaps because of the wide lumen that prevents early stenosis, faecal stasis and secondary ischaemia. A recent meta-analysis showed that side-to-side anastomosis after resection for CD may lead to fewer anastomotic leaks and overall postoperative complications, a shorter hospital stay and a lower perianastomotic recurrence rate compared with end-to-end anastomosis [26,27].…”

Section: Discussionmentioning

confidence: 99%

Clinical and surgical recurrence of Crohnʼs disease after ileocolonic resection in a specialist unit

Lied

Arebi

et al. 2009

European Journal of Gastroenterology & Hepatology

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Section: Discussionmentioning

confidence: 99%

Clinical and surgical recurrence of Crohnʼs disease after ileocolonic resection in a specialist unit

Lied

Arebi

et al. 2009

European Journal of Gastroenterology & Hepatology

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“…There are several factors that confer high risk for recurrence such as smoking history; the NOD/CARD gene mutation; young age at diagnosis; presentation within a short time after diagnosis or the last surgical procedure; intraabdominal sepsis following bowel resection; and multiple-site disease [19e21]. There is still discussion about the type of anastomosis (hand sewn vs stapler or end-to-end vs side-to-side anastomosis); minimal length for negative surgical margins; and the type of surgical procedure (strictureplasty vs resection), all of which may have an impact on recurrence [22,23]. Ileal disease location constitutes a significant risk factor for a second ileocolonic resection [24].…”

Section: Discussionmentioning

confidence: 99%

The analysis of clinico-pathologic characteristics in patients who underwent surgery due to stricturing and non-perineal fistulizing forms of Crohn's disease: A retrospective cohort study

Cayci

Bostancı

Turhan

et al. 2015

International Journal of Surgery

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“…As a result, these authors suggested that the configuration of the anastomosis matters, not necessarily by altering rates of endoscopic recurrence, but by delaying the onset of obstructing symptoms. 3 Still other studies, however, did not seem to support this hypothesis. 4,5 Moreover, 1 meta-analysis of 661 patients with CD (who collectively underwent 712 anastomoses) concluded that the 2 anastomotic techniques did not have a statistically significant difference in recurrence.…”

Section: Commentmentioning

confidence: 86%

Current thinking on recurrence

Bordeianou

Dursun

2010

Inflammatory Bowel Diseases

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A n ambitious randomized controlled study, involving 17 participating sites in the United States, Britain, and Canada, compared rates of endoscopic and symptomatic recurrence in 66 patients who had a stapled side-to-side anastomosis following ileocecal resection for Crohn's disease (CD), versus 73 patients who had a handsewn end-to-end anastomosis. For purposes of the study, endoscopic recurrence was defined as any recurrence with more than 5 aphthous ulcers at the time of a mandated 12-month colonoscopy (i.e., a Rutgeert's score of 2 or higher). Symptomatic recurrence was defined as the presence of endoscopic disease plus symptoms that ''were severe enough to require medical or surgical treatment'' based on the Crohn's Disease Activity Index (CDAI) score, C-reactive protein, and the subject's unspecified ''symptom status.'' At 1 year of follow-up, the 2 groups had similar rates of endoscopic recurrence (37.9% versus 42.5%, P ¼ 0.55) and symptomatic recurrence (22.7% versus 21.9%, P ¼ 0.92). The authors then performed a secondary analysis, which considered other factors that might be associated with recurrence: length of time since diagnosis, number of previous resections, smoking, the presence of fistula or abscess at surgery, length of small bowel affected by CD, type of surgery (open or laparoscopic), postoperative azathioprine therapy, compliance with postoperative azathioprine maintenance, and CDAI at 6 weeks postoperatively. On multivariate logistic analysis, endoscopic and symptomatic recurrence were each higher in patients who had a previous resection and lower in patients who were compliant in azathioprine maintenance therapy. (Anastomotic technique was not included as a variable in the secondary analysis, perhaps due to the assumption that randomization obviated the need to control for confounding.) 1 COMMENTSurgeons have long hypothesized that stapled anastomoses-with their longer length and side-to-side orientation-were associated with a lower rate of recurrence following ileocecal resections for CD. The hypothesis was based on several assumptions. Staples might have lower immunogenicity than sutures. They might well reduce the effects of colonic reflux. In addition, a wider, stapled anastomosis would logically lead to a decrease in fecal stasis.Consistent with these assumptions, some early data tended to support the hypothesis that stapled anastomoses were associated with better long-term recurrence rates. For example, 1 retrospective study compared 69 patients with stapled anastomoses to an equal number of patients with handsewn anastomoses. The study reported that patients who had a stapled anastomosis had a 12% symptomatic recurrence rate at 1 year, as compared to 28% in those with end-to-end handsewn anastomoses.2 At 5 years, 20% of patients treated with a handsewn anastomosis needed repeat surgery, whereas only 11% of the patients in the stapled anastomosis group did.Another retrospective study of 141 consecutive patients also reported a decreased rate of surgical recurrence in patients with wid...

show abstract

Surgical predictors of recurrence of Crohn’s disease after ileocolonic resection

Cited by 54 publications

References 30 publications

Clinical and surgical recurrence of Crohnʼs disease after ileocolonic resection in a specialist unit

Clinical and surgical recurrence of Crohnʼs disease after ileocolonic resection in a specialist unit

The analysis of clinico-pathologic characteristics in patients who underwent surgery due to stricturing and non-perineal fistulizing forms of Crohn's disease: A retrospective cohort study

Current thinking on recurrence

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