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Updated: Jan 8, 2026
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Mesenteric inclusion in Crohn's disease surgery: Promising breakthrough or tempest in a teapot? An updated
Mohamed Maatouk1, Mohamed Ben Khalifa2, Nada Essid1
1A21 Surgery Department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Background:
Recently, renewed concern has been centered on the role of the mesentery in the development of Crohn's disease (CD). However, there are minimal data supporting the extended mesenteric excision (EME), which may lead to reticence in the adoption of this surgical option. This systematic review and meta-analysis aimed to compare the post-operative outcomes in patients undergoing EME vs limited mesenteric excision (LME) for CD.
Methods:
We conducted a systematic search from January 2018 to January 2025 for studies reporting outcomes in patients undergoing EME compared with LME for CD. A pooled meta-analysis was performed. The risk of bias was examined using the ROBINS-I v2 and RoB2 tool.
Results:
Nine studies were included in final analysis, comprising two randomized controlled trials, enrolling a total of 4823 patients. Definitions of EME differ, with some studies preserving the ileocolic trunk and others resecting the mesentery with proximal ligation. No significant difference in surgical or endoscopic recurrence was observed between EME and LME. Concerning secondary outcomes, including overall morbidity, intra-abdominal abscess, anastomotic leak and hospital stay, the two groups showed no significant differences.
Conclusions:
EME appears as safe as the LME in terms of morbidity, but does not significantly reduce surgical or endoscopic recurrence. Due to the absence of a precise definition of the EME procedure in CD and the need of further high-quality research, the approach of EME still lacks sufficient validation and cannot be broadly recommended for routine clinical practice.
Insights
Extended mesenteric excision (EME) for Crohn's disease (CD) shows similar safety and recurrence rates compared to limited mesenteric excision (LME). Further research is needed to validate EME for routine clinical practice.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Inflammatory Bowel Disease Research
Background:
- The mesentery's role in Crohn's disease (CD) pathogenesis is under renewed investigation.
- Limited data exist on extended mesenteric excision (EME), hindering its surgical adoption.
- This study addresses the comparative outcomes of EME versus limited mesenteric excision (LME) in CD patients.
Purpose of the Study:
- To systematically review and meta-analyze post-operative outcomes of EME compared to LME in Crohn's disease.
- To evaluate the safety and efficacy of EME in managing CD.
Main Methods:
- Systematic literature search conducted from January 2018 to January 2025.
- Pooled meta-analysis of nine studies, including two randomized controlled trials with 4823 patients.
- Risk of bias assessed using ROBINS-I v2 and RoB2 tools.
Main Results:
- No significant difference in surgical or endoscopic recurrence between EME and LME groups.
- Similar rates of overall morbidity, intra-abdominal abscess, anastomotic leak, and hospital stay.
- Varied definitions of EME procedures were noted across studies.
Conclusions:
- Extended mesenteric excision (EME) is as safe as limited mesenteric excision (LME) regarding morbidity in Crohn's disease.
- EME does not significantly reduce surgical or endoscopic recurrence rates.
- Lack of a precise EME definition and need for high-quality research preclude broad recommendation for routine practice.
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