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Inclusion of the Mesentery in Ileocolic Resection for Crohn's Disease is Associated With Reduced Surgical Recurrence

Calvin J Coffey1,2,3, Miranda G Kiernan2,3, Shaheel M Sahebally1,2,3

  • 1Department of Surgery, University Hospital Limerick, Limerick, Ireland.

Journal of Crohn'S & Colitis
|January 9, 2018
PubMed
Abstract

Insights

Including the mesentery in ileocolic resection for Crohn's disease significantly reduces surgical recurrence and reoperation rates. Advanced mesenteric disease independently predicts higher recurrence risk.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Inflammatory Bowel Disease

Background:

  • Mesenteric inclusion in colorectal cancer resection improves outcomes.
  • The impact of mesenteric resection on Crohn's disease recurrence is not well-established.
  • Ileocolic resection is a common surgical procedure for Crohn's disease.

Purpose of the Study:

  • To evaluate surgical recurrence rates after ileocolic resection for Crohn's disease with and without mesenteric inclusion.
  • To determine if mesenteric disease severity predicts surgical recurrence in Crohn's disease.

Main Methods:

  • Comparison of recurrence rates between conventional resection (Cohort A) and mesenteric-inclusive resection (Cohort B).
  • Development and application of a mesenteric disease activity index.
  • Correlation of mesenteric disease activity with clinical and serological markers.

Main Results:

  • Reoperation rates were significantly lower in the mesenteric-inclusive group (2.9% vs. 40%).
  • Mesenteric disease severity, quantified by the new index, independently predicted recurrence (HR 4.7).
  • The mesenteric disease activity index correlated strongly with established Crohn's disease activity indices.

Conclusions:

  • Mesenteric inclusion during ileocolic resection for Crohn's disease is associated with reduced rates of surgical recurrence.
  • Mesenteric disease severity is a critical factor influencing surgical outcomes in Crohn's disease.

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