Mesenteric Excision and Exclusion for Ileocolic Crohn’s Disease: Feasibility and Safety of an Innovative, Combined Surgical Approach With Extended Mesenteric Excision and Kono-S Anastomosis

医学 肠系膜 克罗恩病 外科 吻合 球囊扩张 疾病 内科学 气球
作者
Stefan D. Holubar,Rebecca Bassett‐Gunter,Benjamin Click,Jean‐Paul Achkar,Amy L. Lightner,Jeremy M. Lipman,Tracy L. Hull,Miguel Regueiro,Florian Rieder,Scott R. Steele
出处
期刊:Diseases of The Colon & Rectum [Ovid Technologies (Wolters Kluwer)]
卷期号:65 (1): e5-e13 被引量:32
标识
DOI:10.1097/dcr.0000000000002287
摘要

Ileocolic resection for Crohn's disease traditionally does not include a high ligation of the ileocolic pedicle, and most commonly is performed with a stapled side-to-side ileocolic anastomosis. The mesentery has recently been implicated in the pathophysiology of Crohn's disease. Two techniques have been developed and are associated with reduced postoperative recurrence: the Kono-S anastomosis that excludes diseased mesentery and extended mesenteric excision that resects diseased mesentery. We aimed to assess the technical feasibility and safety of a novel combination of techniques: mesenteric excision and exclusion.This initial report is a single-center descriptive study of consecutive adults who underwent mesenteric excision and exclusion for primary or recurrent ileocolic Crohn's disease from September 2020 to June 2021. Medication exposure and endoscopic balloon dilation before surgery were recorded. Phenotype was classified using the Montreal Classification. Thirty-day outcomes were reported. A video of the mesenteric excision and exclusion including the Kono-S anastomosis is presented.Twenty-two patients with ileocolic Crohn's disease underwent mesenteric excision and exclusion: 100% had strictures, 59% had fistulas, 81% were on biologics, and 27% had previous ileocolic resection(s). Seventy-two percent underwent laparoscopic procedures, a mesenteric defect was closed in 86%, omental flaps were fashioned in 77%, and 3 patients were diverted. Median operative time was 175 minutes. Median postoperative stay was 4 days. At 30 days, there were 2 readmissions for reintervention: 1 seton placement and 1 percutaneous drainage of a sterile collection. There were no cases of intra-abdominal sepsis or anastomotic leak.Mesenteric excision and exclusion represents an innovative, progressive, and promising approach that appears to be highly feasible and safe. Further study is warranted to determine if mesenteric excision and exclusion is associated with reduced postoperative recurrence of ileocolic Crohn's disease.

科研通智能强力驱动
Strongly Powered by AbleSci AI
科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
迅速千愁完成签到 ,获得积分10
11秒前
fawr完成签到 ,获得积分10
11秒前
一颗西柚完成签到 ,获得积分10
30秒前
唐唐完成签到,获得积分10
37秒前
strama完成签到,获得积分10
41秒前
苏菲完成签到 ,获得积分10
46秒前
酷波er应助科研通管家采纳,获得10
47秒前
Sally完成签到 ,获得积分10
50秒前
阳炎完成签到,获得积分10
50秒前
欣忆完成签到 ,获得积分10
50秒前
共享精神应助hipig采纳,获得10
52秒前
Tina完成签到 ,获得积分10
56秒前
现代的紫霜完成签到,获得积分10
59秒前
快去爬山完成签到 ,获得积分10
1分钟前
东方越彬发布了新的文献求助10
1分钟前
杪夏二八完成签到 ,获得积分10
1分钟前
咖啡味椰果完成签到 ,获得积分10
1分钟前
1分钟前
满满的都是橙汁完成签到,获得积分10
1分钟前
Axs完成签到,获得积分10
1分钟前
1分钟前
高歌猛进发布了新的文献求助10
1分钟前
summer完成签到 ,获得积分10
1分钟前
海猫食堂完成签到,获得积分10
1分钟前
dm完成签到 ,获得积分10
1分钟前
zhongu发布了新的文献求助10
1分钟前
乔杰完成签到 ,获得积分10
1分钟前
是是是WQ完成签到 ,获得积分0
2分钟前
小明完成签到 ,获得积分10
2分钟前
年轻的醉冬完成签到 ,获得积分10
2分钟前
蛋妮完成签到 ,获得积分10
2分钟前
那些兔儿完成签到 ,获得积分10
2分钟前
2分钟前
hipig发布了新的文献求助10
2分钟前
young完成签到 ,获得积分10
2分钟前
leo完成签到,获得积分10
2分钟前
Deanna完成签到 ,获得积分10
2分钟前
2分钟前
was_3完成签到,获得积分10
2分钟前
要笑cc完成签到,获得积分10
2分钟前
高分求助中
Continuum Thermodynamics and Material Modelling 3000
Production Logging: Theoretical and Interpretive Elements 2700
Les Mantodea de Guyane Insecta, Polyneoptera 1000
Structural Load Modelling and Combination for Performance and Safety Evaluation 1000
Conference Record, IAS Annual Meeting 1977 820
電気学会論文誌D(産業応用部門誌), 141 巻, 11 号 510
Typology of Conditional Constructions 500
热门求助领域 (近24小时)
化学 材料科学 生物 医学 工程类 有机化学 生物化学 物理 纳米技术 计算机科学 内科学 化学工程 复合材料 基因 遗传学 物理化学 催化作用 量子力学 光电子学 冶金
热门帖子
关注 科研通微信公众号,转发送积分 3571332
求助须知:如何正确求助?哪些是违规求助? 3141926
关于积分的说明 9444874
捐赠科研通 2843331
什么是DOI,文献DOI怎么找? 1562830
邀请新用户注册赠送积分活动 731326
科研通“疑难数据库(出版商)”最低求助积分说明 718524