Wide resection of the mesentery with the imposition of an anastomosis separated from it as the operation of choice in Crohn’s disease
Abstract
Taking into account the
statistics, in the treatment of Crohn’s disease of the small intestine and
ileocecal zone, it can be argued that most patients will be operated at least
once in their life and postoperative relapse of the disease is almost
inevitable. The search for new approaches to surgical treatment of Crohn’s
disease of the small intestine is aimed at reducing the frequency of
postoperative relapses. In this paper, we present our own results of surgical
treatment of this pathology.
Material and
methods. A retrospective analysis of cases of inpatient
treatment and subsequent outpatient observation of patients with Crohn’s
disease was carried out at the proctology department of the State Budgetary
Healthcare Institution of the Republic of Bashkortostan City Clinical Hospital
No. 21 in Ufa for the period from 2015 to 2023. A total of 23 patients were
operated on. In 22 (96%) patients, there was a lesion of the ileocecal region,
in 1 patient there was an isolated lesion of the jejunum. Prestenotic dilation
of the small intestine was detected in 11 (47.8%) patients. 3 (13%) patients
underwent emergency surgery due to peritonitis, 12 (52.2%) patients were
operated on for urgent indications due to acute obstructive intestinal
obstruction, 8 (34.8%) due to hormone dependence and hormone resistance. The
work provides a comparative analysis of the results of surgical treatment of
patients with traditional resection of the ileocecal zone with anastomosis and
patients who underwent resection of the ileocecal zone with extended excision
of the mesentery with anastomosis disconnected from the mesentery.
Results. In the group of traditional bowel resection with anastomosis,
endoscopic recurrence of Crohn’s disease is noted in 68.8%, and in the group of
bowel resection with wide excision of the mesentery and imposition of
anastomosis disconnected from the mesentery in 20% of patients. According to
computed enterography data, in the postoperative period in the group of
traditional bowel resection with anastomosis, signs of stricturing were noted
in 9 cases, which is 56.3%. In the group of bowel resection with wide excision
of the mesentery and imposition of anastomosis disconnected from the mesentery,
CT signs of recurrence of the disease were not noted.
Conclusion. Bowel resection with extended resection of the mesentery and imposition
of anastomosis disconnected from the mesentery is statistically significantly
accompanied by a smaller number of anastomotic strictures in the postoperative
period (p=0.03).
Keywords: Crohn’s disease; postoperative recurrence; mesentery
Funding. The study had no sponsor support.
Conflict of
interest. The authors declare no conflict of interest.
For citation: Timerbulatov M.V., Grishina Е.Е., Lopatin D.V., Aitova L.R. Wide resection of the mesentery with the
imposition of an anastomosis separated from it as the operation of choice in
Crohn’s disease. Clinical and Experimental Surgery. Petrovsky Journal. 2024; 12
(4): 120–7. DOI: https://doi.org/10.33029/2308-1198-2024-12-4-120-127 (in Russian)
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