Solafah Abdalla1, Antoine Brouquet2, Léon Maggiori3, Philippe Zerbib4, Quentin Denost5, Adeline Germain6, Eddy Cotte7, Laura Beyer-Berjot8, Nicolas Munoz-Bongrand9, Véronique Desfourneaux10, Amine Rahili11, Jean-Pierre Duffas12, Karine Pautrat13, Christine Denet14, Valérie Bridoux15, Guillaume Meurette16, Jean-Luc Faucheron17, Jérome Loriau18, Françoise Guillon19, Eric Vicaut20, Stéphane Benoist2, Yves Panis3, Jérémie H Lefevre1. 1. Sorbonne Université, Department of Digestive Surgery, AP-HP, Hôpital Saint Antoine, Paris, France; Saint-Antoine IBD Network. 2. Service de Chirurgie Digestive, Hôpital Bicêtre, APHP, Université Paris-Sud, Le Kremlin-Bicêtre, France. 3. Service de Chirurgie Colorectale, Hôpital Beaujon, APHP, Université Paris VII, Clichy, France. 4. Service de Chirurgie Digestive, CHRU Lille, Lille, France. 5. Service de Chirurgie Digestive, CHRU Bordeaux, Bordeaux, France. 6. Service de Chirurgie Digestive, CHRU Nancy, Nancy, France. 7. Service de Chirurgie Digestive, CHRU Lyon-Sud, Pierre-Bénite, France. 8. Service de Chirurgie Digestive, CHRU Marseille-Nord, Marseille, France. 9. Service de Chirurgie Digestive, Hôpital Saint-Louis, APHP, Université Paris VII, Paris, France. 10. Service de Chirurgie Digestive, CHRU Rennes, Rennes, France. 11. Service de Chirurgie Digestive, CHRU Nice, Nice, France. 12. Service de Chirurgie Digestive, CHRU Toulouse-Rangueil, Toulouse, France. 13. Service de Chirurgie Digestive, Hôpital Lariboisière, APHP, Université Paris VII, Paris, France. 14. Service de Chirurgie Digestive, Institut Mutualiste Montsouris, Paris, France. 15. Service de Chirurgie Digestive, CHRU Rouen, Rouen, France. 16. Service de Chirurgie Digestive, CHU Nantes, France. 17. Service de Chirurgie Digestive, CHRU Grenoble, La Tronche, France. 18. Service de Chirurgie Digestive, Hôpital Saint Joseph, Paris, France. 19. Service de Chirurgie Digestive, CHRU Montpellier, Montpellier, France. 20. Unité de recherche clinique, Hôpital Fernand Widal, APHP, Université Paris VII, Paris, France.
Abstract
BACKGROUND AND AIMS: To compare perioperative characteristics and outcomes between primary ileocolonic resection [PICR] and iterative ileocolic resection [IICR] for Crohn's disease [CD]. METHODS: From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgie group. Perioperative characteristics and postoperative results of both groups [431 PICR, 136 IICR] were compared. Uni- and multivariate analyses of the risk factors of overall 30-day postoperative morbidity was carried out in the IICR group. RESULTS: IICR patients were less likely to be malnourished [27.2% vs 39.9%, p = 0.007], and had more stricturing forms [69.1% vs 54.3%, p = 0.002] and less perforating disease [19.9% vs 39.2%, p < 0.001]. Laparoscopy was less commonly used in IICR [45.6% vs 84.5%, p < 0.01] and was associated with increased conversion rates [27.4% vs 14.6%, p = 0.012]. Overall postoperative morbidity was 36.8% in the IICR group and 26.7% in the PICR group [p = 0.024]. There was no significant difference between IICR and PICR regarding septic intra-abdominal complications, anastomotic leakage [8.8% vs 8.4%] or temporary stoma requirement. IICR patients were more likely to present with non-infectious complications and ileus [11.8% vs 3.7%, p < 0.001]. Uni- and multivariate analyses did not identify specific risk factors of overall postoperative morbidity in the IICR group. CONCLUSIONS: Surgery for recurrent CD is associated with a slight increase of non-infectious morbidity [postoperative ileus] that mainly reflects the technical difficulties of these procedures. However, IICR remains a safe therapeutic option in patients with recurrent CD because severe morbidity including anastomotic complications is similar to patients undergoing primary resection. PODCAST: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
BACKGROUND AND AIMS: To compare perioperative characteristics and outcomes between primary ileocolonic resection [PICR] and iterative ileocolic resection [IICR] for Crohn's disease [CD]. METHODS: From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgie group. Perioperative characteristics and postoperative results of both groups [431 PICR, 136 IICR] were compared. Uni- and multivariate analyses of the risk factors of overall 30-day postoperative morbidity was carried out in the IICR group. RESULTS:IICRpatients were less likely to be malnourished [27.2% vs 39.9%, p = 0.007], and had more stricturing forms [69.1% vs 54.3%, p = 0.002] and less perforating disease [19.9% vs 39.2%, p < 0.001]. Laparoscopy was less commonly used in IICR [45.6% vs 84.5%, p < 0.01] and was associated with increased conversion rates [27.4% vs 14.6%, p = 0.012]. Overall postoperative morbidity was 36.8% in the IICR group and 26.7% in the PICR group [p = 0.024]. There was no significant difference between IICR and PICR regarding septic intra-abdominal complications, anastomotic leakage [8.8% vs 8.4%] or temporary stoma requirement. IICRpatients were more likely to present with non-infectious complications and ileus [11.8% vs 3.7%, p < 0.001]. Uni- and multivariate analyses did not identify specific risk factors of overall postoperative morbidity in the IICR group. CONCLUSIONS: Surgery for recurrent CD is associated with a slight increase of non-infectious morbidity [postoperative ileus] that mainly reflects the technical difficulties of these procedures. However, IICR remains a safe therapeutic option in patients with recurrent CD because severe morbidity including anastomotic complications is similar to patients undergoing primary resection. PODCAST: This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
Authors: Christian Schineis; Andrea Ullrich; Kai S Lehmann; Christoph Holmer; Johannes C Lauscher; Benjamin Weixler; Martin E Kreis; Claudia Seifarth Journal: PLoS One Date: 2021-03-04 Impact factor: 3.240
Authors: Francesco Colombo; Alice Frontali; Caterina Baldi; Maria Cigognini; Giulia Lamperti; Carlo A Manzo; Giovanni Maconi; Sandro Ardizzone; Diego Foschi; Gianluca M Sampietro Journal: Updates Surg Date: 2021-11-01