Postoperative Morbidity After Iterative Ileocolonic Resection for Crohn’s Disease: Should we be Worried? A Prospective Multicentric Cohort Study of the GETAID Chirurgie
Year: 2019
Type: article
Study design: Observational Study
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.
Source: Journal of Crohn s and Colitis
Authors: Solafah Abdalla, Antoine Brouquet, Léon Maggiori, Philippe Zerbib, Quentin Denost, Adeline Germain, Eddy Cotte, Laura Beyer-Berjot, Nicolas Munoz-Bongrand, Véronique Desfourneaux, Amine Rahili, Jean-Pierre Duffas, Karine Pautrat, Christine Denet, Valérie Bridoux, Guillaume Meurette, Jean-Luc Faucheron, Jérome Loriau, Françoise Guillon, Eric Vicaut, Stéphane Benoist, Yves Panis, Jérémie H Lefevre, GETAID Chirurgie Group
Institutions: Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Antoine, Université Paris-Sud, Bicêtre Hospital, Hôpital Beaujon, Université Paris Diderot, Centre Hospitalier Universitaire de Lille, Centre Hospitalier Universitaire de Bordeaux, Centre Hospitalier Régional et Universitaire de Nancy, Hôpital Lyon Sud, Hôpital Nord, Hôpital Saint-Louis, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes, Centre Hospitalier Universitaire de Nice, Hôpital Rangueil, Hôpital Lariboisière, Institute Mutualiste Montsouris, Institute for Research and Innovation in Biomedicine, Centre Hospitalier Universitaire de Rouen, Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire de Grenoble, Hôpital Paris Saint-Joseph, Centre Hospitalier Universitaire de Montpellier, Hôpital Fernand-Widal
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2943793348