BACKGROUND AND AIMS: Rectal resection in inflammatory bowel disease [IBD] is frequently complicated by disturbed perineal wound healing. Close rectal dissection, where the mesorectum remains in situ, is hypothesized to reduce complications by minimizing dead space, compared to total mesorectal excision. The aim of this study was to analyse post-operative outcomes of both techniques. In addition, immune activity in mesorectal tissue was assessed. METHODS: Perineal complications and healing were retrospectively assessed in a series of 74 IBD patients undergoing proctectomy using close rectal dissection or total mesorectal excision. The mesorectums of 15 patients were analysed by fluorescence-activated cell sorting, immunofluorescence and in situ hybridization. Based on the clinical and in vitro findings, a novel surgical approach for Crohn's disease patients with disturbed perineal healing after proctectomy was developed. RESULTS: In Crohn's disease, perineal complications were more frequent after close rectal dissection than after total mesorectal excision [59.5% vs 17.6%; p = 0.007] with lower healing rates [51.4% vs 88.2%; p = 0.014]. No differences were observed in ulcerative colitis. The mesorectal tissue in Crohn's disease contained enhanced numbers of tumour necrosis factor α-producing CD14+ macrophages, with less expression of the wound-healing marker CD206. Based on these findings, mesorectal excision with omentoplasty was performed in eight patients with perineal complications after close rectal dissection, resulting in complete perineal wound closure in six. Pro-inflammatory characteristics remained present in the mesorectum after close rectal dissection in these patients. CONCLUSIONS: In Crohn's disease, close rectal dissection resulted in more perineal complications, associated with a pro-inflammatory immune status of the mesorectal tissue. Excision of this pro-inflammatory mesenteric tissue resulted in improved perineal healing rates.
BACKGROUND AND AIMS: Rectal resection in inflammatory bowel disease [IBD] is frequently complicated by disturbed perineal wound healing. Close rectal dissection, where the mesorectum remains in situ, is hypothesized to reduce complications by minimizing dead space, compared to total mesorectal excision. The aim of this study was to analyse post-operative outcomes of both techniques. In addition, immune activity in mesorectal tissue was assessed. METHODS: Perineal complications and healing were retrospectively assessed in a series of 74 IBD patients undergoing proctectomy using close rectal dissection or total mesorectal excision. The mesorectums of 15 patients were analysed by fluorescence-activated cell sorting, immunofluorescence and in situ hybridization. Based on the clinical and in vitro findings, a novel surgical approach for Crohn's disease patients with disturbed perineal healing after proctectomy was developed. RESULTS: In Crohn's disease, perineal complications were more frequent after close rectal dissection than after total mesorectal excision [59.5% vs 17.6%; p = 0.007] with lower healing rates [51.4% vs 88.2%; p = 0.014]. No differences were observed in ulcerative colitis. The mesorectal tissue in Crohn's disease contained enhanced numbers of tumour necrosis factor α-producing CD14+ macrophages, with less expression of the wound-healing marker CD206. Based on these findings, mesorectal excision with omentoplasty was performed in eight patients with perineal complications after close rectal dissection, resulting in complete perineal wound closure in six. Pro-inflammatory characteristics remained present in the mesorectum after close rectal dissection in these patients. CONCLUSIONS: In Crohn's disease, close rectal dissection resulted in more perineal complications, associated with a pro-inflammatory immune status of the mesorectal tissue. Excision of this pro-inflammatory mesenteric tissue resulted in improved perineal healing rates.
Authors: Éanna J Ryan; Gabriel Orsi; Michael R Boland; Adeel Zafar Syed; Ben Creavin; Michael E Kelly; Kieran Sheahan; Paul C Neary; Dara O Kavanagh; Deirdre McNamara; Des C Winter; James M O'Riordan Journal: Int J Colorectal Dis Date: 2020-01-09 Impact factor: 2.571
Authors: Marte A J Becker; Eline M L van der Does de Willebois; Willem A Bemelman; Manon E Wildenberg; Christianne J Buskens Journal: Clin Colon Rectal Surg Date: 2022-07-04
Authors: Stefan D Holubar; Rebecca L Gunter; Benjamin H Click; Jean-Paul Achkar; Amy L Lightner; Jeremy M Lipman; Tracy L Hull; Miguel Regueiro; Florian Rieder; Scott R Steele Journal: Dis Colon Rectum Date: 2022-01-01 Impact factor: 4.412
Authors: Waqas T Butt; Éanna J Ryan; Michael R Boland; Eilis M McCarthy; Joseph Omorogbe; Karl Hazel; Gary A Bass; Paul C Neary; Dara O Kavanagh; Deirdre McNamara; James M O'Riordan Journal: Int J Colorectal Dis Date: 2020-02-11 Impact factor: 2.571
Authors: Francesca Aparecida Ramos da Silva; Lívia Bitencourt Pascoal; Isabella Dotti; Maria de Lourdes Setsuko Ayrizono; Daniel Aguilar; Bruno Lima Rodrigues; Montserrat Arroyes; Elena Ferrer-Picon; Marciane Milanski; Lício Augusto Velloso; João José Fagundes; Azucena Salas; Raquel Franco Leal Journal: J Transl Med Date: 2020-01-30 Impact factor: 5.531
Authors: L Petagna; A Antonelli; C Ganini; V Bellato; M Campanelli; A Divizia; C Efrati; M Franceschilli; A M Guida; S Ingallinella; F Montagnese; B Sensi; L Siragusa; G S Sica Journal: Biol Direct Date: 2020-11-07 Impact factor: 4.540
Authors: Corine A Lansdorp; Christianne J Buskens; Krisztina B Gecse; Geert Ram D'Haens; Rob A Van Hulst Journal: United European Gastroenterol J Date: 2020-06-12 Impact factor: 4.623