Should surgery be broader?

#IBD  #CrohnsDisease  #Surgery  #Intestine  #Inflammation    


Crohn’s disease (CD) is a chronic inflammation of the digestive tract that progresses in flare-ups. It primarily affects the terminal ileum and colon. While drug treatments (anti-inflammatory drugs, immunosuppressants, biologics) help control the disease, 60 to 70% of patients require surgery at some point in their life. Surgery is particularly indicated in cases of severe complications such as strictures, fistulas, or abscesses.   

Extended mesenteric resection involves removing the diseased intestine along with a larger portion of the mesentery. The mesentery, a membrane containing blood vessels and immune cells, plays a key role in inflammation.

Although this approach appears promising, it does not prevent recurrence. Up to 50% of operated patients relapse within 10 years, and one-third require another surgery. Additionally, concerns exist regarding potential postoperative complications. Some surgeons prefer to preserve the mesentery to avoid vascular complications.

This study analyzes the impact of this surgical approach on recurrence and postoperative complications to determine whether it genuinely improves the management of Crohn’s disease patients.  

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Fewer recurrences with a broader resection?

Five comparative studies, including a total of 4,358 patients, were selected. The patients were randomly divided into two groups:

• Extended mesenteric resection.
• Mesenteric preservation.

The two groups were compared by analyzing the following outcome variables: surgical recurrence rate, endoscopic recurrence, length of hospital stay, and postoperative morbidity.  

Extended mesenteric resection significantly reduced the surgical recurrence rate compared to mesenteric preservation (OR = 4.94; 95% CI [2.22–10.97]; p < 0.001). However, no significant impact was observed on endoscopic recurrence, length of hospital stay, or postoperative morbidity. These results suggest that mesentery removal plays a key role in preventing surgical recurrences.  

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An effective solution, but more evidence needed!

Crohn’s disease is a chronic inflammatory condition of the digestive tract, progressing through flare-ups and leading to complications such as strictures, fistulas, and abscesses. When drug treatments are no longer sufficient, surgery becomes inevitable for nearly 70% of patients.  

Despite surgical intervention, the disease frequently recurs. Up to 50% of operated patients relapse within 10 years, and one-third require another surgery. The extent of resection, particularly whether to remove the mesentery, remains a topic of debate. Some surgeons believe preserving it is preferable, while others argue that a broader resection could reduce recurrence.  

This study aims to evaluate the impact of complete mesenteric excision during intestinal resection on the risk of recurrence and postoperative complications in Crohn’s disease patients.  

The results suggest that extended mesenteric resection significantly reduces the risk of repeat surgery without increasing postoperative complications.  

However, these findings should be interpreted with caution, as they are based on only five studies, with only one being randomized. Furthermore, surgical techniques vary, and postoperative follow-up is not standardized. Larger clinical trials and extended follow-up are needed to confirm these conclusions and determine the best surgical approach to limit Crohn’s disease recurrence.

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