Decreasing disease recurrence rates after ileocecal resection for Crohn’s disease. Do surgical techniques matter?
Posted in Lectures on 24 August 2017
Wirral University Teaching Hospital (UK)
Approximately 70% of patients with Crohn’s Disease will require surgery after 10 years of disease evolution and around 50% of Crohn’s Disease patients have an ileocecal distribution. After resection, there is a risk of relapse of 28% at 5 years and 36% at 10 years
Dr. Walsh reviews the published literature on the risk factors for recurrence after resection for ileocecal Crohn’s Disease. He reviews the importance of the surgical approach (open vs. laparoscopic) and the effect of the presence of microscopic disease in the surgical margin. A thorough description of the different anastomotic techniques is offered as well as a review of the literature, showing that there are no differences in the recurrence rate. Based on published data, Dr. Walsh explains that the calculated stricturoplasty site-specific recurrence rate is 3%.
The Kono-S anastomosis technique is discussed and its effect on the recurrence rate is reviewed, showing a 5- and 10-year recurrence-free survival of 98.6%. Dr. Walsh states that the results of an ongoing Randomized Clinical Trial must be known before this technique is implemented in clinical practice is necessary.
Finally, he reviews the effect of the mesentery on the recurrence of Crohn’s Disease.