Buscar en
Revista Médica Clínica Las Condes
Toda la web
Inicio Revista Médica Clínica Las Condes SURGICAL STRATEGIES IN MULTIDISCIPLINARY MANAGEMENT OF CROHN'S DISEASE
Información de la revista
Vol. 30. Núm. 5.
Tema central: Enfermedad Inflamatoria Intestinal parte II
Páginas 349-356 (Septiembre - Octubre 2019)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Visitas
519
Vol. 30. Núm. 5.
Tema central: Enfermedad Inflamatoria Intestinal parte II
Páginas 349-356 (Septiembre - Octubre 2019)
REVISTA MÉDICA CLÍNICA LAS CONDES
DOI: 10.1016/j.rmclc.2019.07.007
Open Access
SURGICAL STRATEGIES IN MULTIDISCIPLINARY MANAGEMENT OF CROHN'S DISEASE
ESTRATEGIAS QUIRÚRGICAS EN EL MANEJO MULTIDISCIPLINARIO DE LA ENFERMEDAD DE CROHN
Visitas
...
Claudio Saddy Rodrigues Coya,
Autor para correspondencia
pkotze@hotmail.com

Corresponding author.
, Paulo Gustavo Kotzeb
a Colorectal Surgery Unit, Campinas State University (UNICAMP), Campinas, Brazil
b IBD outpatient clinics, Pontificia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
Información del artículo
Resumen
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (5)
Mostrar másMostrar menos
Abstract

Despite significant advances in medical therapy, particularly biological agents, a significant number of patients still need surgery as an important therapeutic tool in Crohn's disease (CD). The role of a surgeon in the multidisciplinary team in inflammatory bowel disease care is essential. Discussion with gastroenterologists, radiologists and dietitians to proper define the best timing of surgery after optimization and the best surgical strategy that will be used impact in better postoperative outcomes in CD patients. In this review the authors discuss important aspects involved in the surgical strategies of the multidisciplinary management of CD, including preoperative planning and optimization, the definition of the more adequate approach and technique according to the disease location, and adequate prevention of postoperative recurrence. Several aspects including patients’ past and present features are important in making the right decision in the surgical management of CD. Adequate preparation of the nutritional status, correction of anemia, optimization of medical therapy and anatomic mapping of the small bowel and colon with imaging tests are essential for the definition of best timing and type of surgery in abdominal resections in CD patients. This fact demonstrates the specific need for a multidisciplinary team in the management of CD surgical patients.

Keywords:
Crohn's disease
General surgery
Postoperative complications
Resumen

A pesar de los avances significativos en la terapia médica, particularmente de los agentes biológicos, aún un número significativo de pacientes con enfermedad de Crohn (EC) necesitará de la cirugía como una importante estrategia terapéutica. El papel del coloproctólogo en el equipo multidisciplinario de enfermedad inflamatoria intestinal es fundamental. La discusión con gastroenterólogos, radiólogos y nutriólogos para definir el mejor momento de la cirugía post optimización y la mejor estrategia quirúrgica que se utilizará, impactará en mejores resultados postoperatorios en pacientes con EC. En esta revisión, discutimos importantes aspectos relacionados con las estrategias quirúrgicas del manejo multidisciplinario de la EC, incluyendo el manejo preoperatorio y optimización, la definición del enfoque y la técnica más adecuada de acuerdo a la ubicación de la enfermedad y la prevención más apropiada para el manejo de la recurrencia postoperatoria. Otras variables tales como los antecedentes y las características actuales del paciente, son importantes para tomar la decisión correcta en el tratamiento quirúrgico de la EC. La adecuada preparación del estado nutricional, la corrección de la anemia, la optimización de la terapia médica y la evaluación del intestino delgado y del colon a través de estudios de imágenes son esenciales para definir el mejor momento y el tipo de cirugía en las resecciones intestinales en pacientes con EC. Este hecho muestra la necesidad de un equipo multidisciplinario especializado en el manejo de pacientes quirúrgicos con EC.

Palabras clave:
Enfermedad de Crohn
Cirugía general
Complicaciones postoperatorias
Texto completo
1INTRODUCTION

Crohn's disease (CD) can be associated with structural damage in the bowel. The natural history of CD is usually constituted by an evolution from inflammatory lesions at the mucosal level to stenosis and consequent perforation, as abscesses and internal or external fistulas1. Unfortunately, in some cases, irreversible damage of an intestinal segment appears at the beginning of the disease course, or even in the presence of optimal medical therapy2.These constitute the most common indications for surgery, despite most dramatic scenarios such as intestinal perforation, toxic megacolon or cancer may be present in the long-term disease course of a CD patient. Actually, in spite of the advances in medical therapy, particularly biological agents, a significant number of patients still need surgery as an important tool in the therapeutic armamentarium3,4 and the available data are controversial regarding reduction in surgery rates after the biologic era5–10.

Chronic evolution and heterogenous biological behavior are associated with different clinical presentations in CD. Choosing the best time for surgery is difficult and surgeons have to deal with different scenarios, from simple stenosis to larger inflammatory masses involving more than one intestinal segment or adjacent structures. All these aspects interfere with the definition of the more adequate surgical approach, post-operative morbidity and long-term outcomes. The basic pillars of surgical therapy in CD are identification of risk factors associated with complications; performing economic intestinal resections; bowel preserving surgery (strictureplasties whenever possible); adequate preoperative optimization and different surgical options according to the location and phenotype of the disease.

The aim of this review is to discuss important aspects involved in the surgical strategies of the multidisciplinary management of CD, including preoperative planning and optimization, definition of the more adequate approach and surgical technique according to disease location, and adequate prevention of postoperative recurrence.

2PREOPERATIVE PLANNING2.1A IMAGING METHODS

Adequate identification of affected intestinal segments is crucial for preoperative planning in abdominal CD, particularly with minimally invasive techniques including single-port, laparoscopic or robotic surgery. Three modalities of tests are currently available with adequate correlation with intra- operative findings: ultrasonography (US), MRE (magnetic ressonance enterography) or CTE (computed tomography enterography). All these types of imaging modalities are able to identify disease complications such as stenosis, abscesses, internal or external fistulas and even active inflammation at different layers of the bowel11,12.These findings are important for adequate differentiation between fibrotic or inflammatory stenosis and are useful for planning the extension of intestinal resection or for better definition of proper intestinal segments which can be suitable to strictureplasties.

US is a less expensive method, with no exposure to radiation. The examination, usually aiming evaluation of the small bowel and colon, is usually fast and well tolerated, with good correlation to CTE or MRE findings in different studies, in expert hands13,14. It allows adequate identification of bowel wall thickness, presence of abscesses, and precise definition of primary and secondary segments in fistulas. However, it is operator dependent and review of imaging findings can be challenging, as it is a dynamic test.

MRE (figure 1) and CTE (figure 2) have similar sensitivity for differentiation between inflammatory or fibrotic stenosis and are able to identify fistulous tracks or even specific features in retroperitoneal spaces or within pelvis15,16. Both methods require specific protocols and oral fluid intake for intestinal distension (usually laxatives). MRE has a big advantage over CTE, as there is no radiation exposure. However, the test usually demands longer periods inside imaging equipment, what can cause discomfort to some patients, secondary to claustrophobic sensation. Regarding preoperative evaluation, particularly with laparoscopic or robotic approaches, which can sometimes lead to difficulties in intraoperative evaluation of the whole extension of small bowel, MRE and CTE must be considered as the methods of choice. They are associated to better correlation with the intraoperative findings, since US has limitations regarding the view of the small intestine as a whole.

Figure 1.

Computed Tomography Enterography (CTE) of a patient with terminal ileal Crohn's disease.

(0,22MB).
Figure 2.

Magnetic Ressonanse Enterography (MRE) of a patient with terminal proximal small bowel Crohn's disease with internal fistula and small bowel proximal dilatation.

(0,12MB).

Currently, no adequate surgical indication can be done without preoperative adequate imaging mapping. For that reason, a close relation between the surgeon and radiologist is essential for adequate surgical planning and constitute one of the most important aspects of the multidisciplinary team in inflammatory bowel disease units over the globe.

2.2B. PREOPERATIVE NUTRITIONAL EVALUATION AND OPTIMIZATION

Malnutrition is frequent in CD patients secondary to insufficient dietary intake, malabsorption and systemic inflammation which can cause catabolism and reduced protein synthesis. Particularly in patients who are candidates to major abdominal surgery, all these three aspects may be present in association. For example, a patient with ileal involvement with poor therapeutic response frequently can be present with stenosis and active luminal inflammation. Poor nutritional status, evidenced by weight loss greater than 10% of body weight, serum albumin lower than 3g/dl and a BMI lower than 18,5kg/m2 are associated with worse postoperative outcomes in CD17,21. Hypoalbuminemia is strongly associated with worse postoperative outcomes and preoperative nutrition treatment can reduce overall complications and the need for stomas18,22.

Exclusive enteral nutrition (EEN) is an effective bridge to better timing of elective surgery for malnourished adults with CD. In patients with phlegmons or other semi-urgent surgical indications, preoperative optimization with EEN helps patients in two ways: reduction of the inflammatory burden and correction of associated malnutrition24–26. EEN is cheaper than parenteral nutrition (PN) and avoids central catheter complications. A retrospective study showed a clear benefit with EEN 3 months prior to surgery, with less intraoperative septic conditions and better surgical outcomes27. Some studies reported that the use of preoperative total parenteral nutrition was also associated with lower post-operative morbidity, when the enteral route could not be used28,29.

Thus, nutritional supplementation has been associated with a positive impact and better postoperative outcomes in major abdominal surgery in CD, and it is recommended even if the surgical procedure needs to be postponed. It must be considered that the best route or supplemental duration necessary to be employed are not yet well determined in the literature and need to be defined in an individualized basis in the multidisciplinary team, together with gastroenterologists and dietitians.

2.3C. PREOPERATIVE MEDICAL THERAPY

Most of CD patients who undergo surgery have a previous history of medical treatment failure and most of them are under treatment with immunosuppressive drugs or biological agents. Thus, the impact of perioperative medical therapy needs to be considered regarding its effect in postoperative outcomes. It is well established that steroids have a negative impact and increase the risk of infectious and overall postoperative complications30. Tzivanakis et al. showed that for ileocolic resections, the use of corticosteroids in patients with abdominal abscesses is associated with dehiscences in up to 40% of the cases, and surgeons must consider the need for intestinal stomas in these situations31. In this study, previous steroids (OR 2.67, 95% CI 1.0-7.2) and preoperative abscesses (OR 3.4, 95% CI 1.2-9.8) were identified as independent predictors of anastomotic complications. In the absence of both steroids and intra-abdominal abscess, the risk of anastomotic complications was only 6%, which increased to 14% if either risk factor was present. When both risk factors were present, complication rates reached 40%. There is scarce data regarding the postoperative impact of preoperative use of immunomodulators such as azathioprine, 6-mercaptopurine or methotrexate, but the majority of the studies demonstrate that this class of drugs can be safely used in the perioperative period, and do not increase morbidity32.

The impact of preoperative use of biological therapy in major abdominal surgery in CD patients remains controversial. Nowadays, many patients who undergo surgery are previously using biological therapy and concerns regarding septic and anastomotic complications are still present. The use of anti-TNF (tumor necrosis factor) agents has been associated with septic complications according to a meta-analysis33.Another multicentric study suggested that the preoperative use of anti-TNF agents can be associated with higher anastomotic leak rates after ileocolic resections34. Several studies did not find a negative association between biologics and worse postoperative outcomes, and current data are controversial probably due to methodological discrepancies35–37.

Few prospective studies were published over this topic. Lau et al. showed that there may be an association between higher serum levels of infliximab and overall postoperative complications in CD patients, but not in ulcerative colitis38.More prospective studies with other biological agents, such as vedolizumab and ustekinumab are also warranted.

2.4D. THROMBOEMBOLISM PROPHYLAXIS

Inflammatory bowel diseases are associated with greater risk of thromboembolic events (TEE), mostly in patients with high inflammatory burden, and during hospital admissions with or without an associated surgical procedure, with a prevalence as high as 39% in necropsies39,40. Imbrizi et al. identified the occurrence of 15.1% of venous thrombosis in hospitalized CD patients and the authors described that low serum levels of albumin were a strong predictor of this occurrence41.

Postoperative CD patients have even a greater risk for thromboembolic events. Since specific conditions associated with surgery such as positioning on the operating table, dehydration, long-standing surgery, thrombophilia and steroid use predispose to these events42. Adequate prophylaxis with pneumatic intermittent compression in the lower limbs during hospital stay and the use of low molecular weight heparin must be employed until 4 weeks after discharge in specific cases. The ECCO (European Crohn's and Colitis Organisation) guidelines CD state that a combination of mechanical and pharmacological thrombosis prophylaxis should be considered in CD patients requiring surgery, and extended for 4 weeks in all IBD patients32.

3SMALL BOWEL CD: STRICTUREPLASTY VERSUS SEGMENTAL RESECTION

Patients with CD have an increased risk of multiple operations and prevention of intestinal failure is one of the main goals of surgical therapy. In small bowel location, bowel preserving surgical techniques are largely employed with good results and low morbidity. Since stenosis is the most frequent indication for surgery, strictureplasties constitute a good option for cases with multiple involved segments or previous surgical resections43.

There are multiple options of types of strictureplasties, according to the number and extension of the stenosis. The Heineke-Mikulicz technique is the most used procedure, with a clear indication for short and multiple stenosis (figure 3). It is performed by opening the stenosis longitudinally and closing the defect transversely, increasing the diameter of the affected bowel. This is a safe technique, and despite performed sometimes in inflamed tissue, leak rates are low. The Finney technique may be an option for longer stenosis, but in the authorś personal experience is often associated with recurrence and stenosis at the mesenteric junction of the bowel segments, leading in some cases to dilatation, bacterial overgrowth, functional motility problems and diarrhea. Stenosis which are associated to internal or external fistulas constitute an absolute contraindication for bowel preserving surgery with strictureplasties, due to higher risk of anastomotic dehiscence. More recently, longer strictureplasties as the Michelassi procedure or the ileocecal side-to-side technique were described. These strategies have a special role in patients with multiple previous resections, avoiding short bowel syndrome. The results in experienced centers are comparable with other strictureplasties, and the decision of their application in clinical practice needs to be individualized in a multidisciplinary manner44,45.

Figure 3.

Heineke-Mikulicz technique for multiple short stenosis in the terminal ileum of a CD patient.

(0,15MB).

As the most common location of CD is the terminal ileum and ileocecal junction, ileocolonic resection is the most common abdominal surgical procedure performed. Intrinsic difficulties regarding the friable mesentery need to be taken into account in this operation. After resection, anastomotic techniques do not appear to affect the postoperative outcome with similar results comparing end-to-end versus side-to-side ileocolonic anastomosis46. Nevertheless, anti-peristaltic side-to-side anastomosis (functional end-to-end) makes the evaluation of the neoterminal ileum difficult in future colonoscopies to evaluate endoscopic recurrence, and for this reason the authors recommend avoidance of this technique. Isoperistaltic side-to-side anastomosis is the preferred technique and can be performed with open surgery or by the laparoscopic approach (intra or extracorporeally).

It is known that different variations in surgical procedures do not affect recurrence. Recently, Coffey et al. described a technical aspect probably associated with lower recurrence rates. The authors demonstrated lower surgical recurrence with the extension of the ileocolic resection with the corresponding mesentery. The possible explanation for these findings is that the excision of the mesentery removes lymphoid tissue, diminishing the local influx of inflammatory cells towards the bowel layers. Future studies comparing mesenteric preservation or excision are warranted in the IBD field47.

4COLONIC CD: SEGMENTAL VERSUS TOTAL COLECTOMY

Colonic involvement represents a challenging location for the surgical management of CD. Usually, toxic megacolon, associated cancer, dysplasia or major bleeding are indications for total colectomy, despite being rare situations seen in clinical practice. Segmental resections are usually indicated when one segment of the colon is affected (figure 4). They are less technically demanding but are associated with higher recurrence rates and must be considered in cases with associated small bowel involvement or perianal disease. In patients with multiple affected colonic segments, a total colectomy is indicated when there is no perianal disease and the rectum is spared, in association with an ileorectal anastomosis. Patients with rectal involvement and perianal disease can be candidates for a total proctocolectomy and a permanent ileostomy. A meta-analysis demonstrated similar results with total or segmental colectomy in terms of complications. Recurrence rates seem to be higher in segmental resections, despite better functional results. Most of the studies comparing segmental versus total colectomies were performed before the overspread use of biological therapy. If the use of biologics increased the number of segmental resections, this still needs to be proved32,48.

Figure 4.

Specimen of a segmental colectomy in a CD patient with a single segment of the colon involved by the disease.

(0,33MB).
5LAPAROSCOPIC SURGERY IN CD

The laparoscopic approach in CD is associated with all the advantages of laparoscopy, as better cosmesis, reduced surgical trauma, more rapid recovery and shorter hospital stay. With advances in surgical technique and equipment, laparoscopy remains the gold standard approach in abdominal surgery for CD (figure 5). Even in patients with previous operations or penetrating phenotype, laparoscopic resections are feasible and associated with good results. The more experienced the center is, the lower the conversion rates will be49,50. Despite several advantages, the use of laparoscopic techniques is not associated to differences in terms of postoperative endoscopic recurrence51.

Figure 5.

Laparoscopic inspection of a terminal ileum with fat wrapping and associated stenosis in a CD patient.

(0,11MB).

Some characteristics from CD may not be favorable for laparoscopic procedures in less experienced hands, as previous abdominal surgeries, incisional hernias, involvement of multiple segments or the penetrating phenotype. However, when feasible, it allows adequate inspection of the abdominal cavity, less morbidity and lower stoma rates34. This makes the laparoscopic approach the best option for most CD patients.

6PREVENTION OF POSTOPERATIVE RECURRENCE IN CD

Endoscopic findings after ileocolic resection are good predictors of CD recurrence and precede clinical symptoms52. Before the introduction of more effective therapeutic regimens, endoscopic recurrence rates were described to be as high as 90% with a high prevalence of the need for reoperation in the long-term53,54. There are clear limitations with the use of conventional therapy in prevention of endoscopic recurrence in CD. Hanauer et al. showed no differences in prevention of postoperative recurrence when comparing mesalazine, 6-mercaptopurine or placebo55. A large multicentric study showed benefits with 6-maercaptopurine only in smokers, and the role of thiopurines in preventing recurrence is questionable, despite some published evidence56.

Anti TNF agents are considered to be more effective than conventional therapy in prevention of postoperative recurrence in CD and their use in postoperative period has the potential benefit of a better disease control. Biologic therapy appears to be more efficient in prevention of endoscopic recurrence as compared to conventional therapy in two prospective trials despite short follow-up and low number of patients57,58. A systematic review with meta-analysis also demonstrated the higher efficacy of anti-TNF agents in preventing endoscopic recurrence59. The PREVENT trial was the largest prospective study to date to compare recurrence between patients with infliximab and conventional therapy with infusions of placebo. Despite not achieving the primary endpoint (clinical recurrence), the rates of endoscopic recurrence after 76 weeks were lower in the infliximab group as compared to placebo60.

The choice for optimal therapeutic regimen after surgery must take into account many aspects of the disease such as: the presence of residual disease after ileocolic resection, the use of anti TNF agents before surgery and the presence of different risk factors for recurrence such as smoking and perianal disease. Kotze et al., suggested an individual approach considering the heterogeneity of the presentations and various aspects associated with high or low risk including patient's characteristics, phenotype and histological findings. The choice of the best treatment needs to be individualized and tailored in a case-by-case analysis61.

7FINAL MESSAGES

As seen in this descriptive review, several aspects including patients’ past and present features are important in making the right decision in the surgical management of CD. Adequate preparation of the nutritional status, optimization of medical therapy and anatomic mapping of the small bowel and colon with imaging tests are essential for the best timing of surgery in abdominal resections in CD patients. This fact demonstrates the specific need for a multidisciplinary team in the management of these patients, what impacts the postoperative outcomes with better results.

Adequate surgical technique is important, but does not represent everything in achieving success in major abdominal surgery in CD. Some aspects as the correction of anemia and adequate prevention of thromboembolic events are usually neglected, and need to be emphasized in the multidisciplinary approach that these patients need.

The journey of a surgical CD patient initiates in the gastroenterologist's clinics, passes through the operation itself, postoperative period and does not have an end. As the disease does not have a cure, many efforts in preserving bowel and avoiding intestinal failure and optimization strategies aiming prevention of recurrence are needed. Each patient needs to be seen as a different one, and the therapeutic strategies need to be individualized. The role of the surgeon in a multidisciplinary IBD team is essential for adequate patient care.

8Author's Disclousure

Claudio Coy has no disclosures.

Paulo Kotze is a speaker and consultant for Abbvie, Janssen, Takeda and Pfizer.

References
[1]
D.C. Baumgart, W.J. Sandborn.
Crohn's disease.
Lancet., 380 (2012), pp. 1590-1605
[2]
K.T. Thia, W.J. Sandborn, W.S. Harmsen, A.R. Zinsmeister, E.V. Loftus Jr..
Risk factors associated with progression to intestinal complications of Crohn's disease in a population-based cohort.
Gastroenterology, 139 (2010), pp. 1147-1155
[3]
L. Peyrin-Biroulet, A. Oussalah, N. Williet, C. Pillot, L. Bresler, M.A. Bigard.
Impact of azathioprine and tumour necrosis factor antagonists on the need for surgery in newly diagnosed Crohn's disease Gut., 60 (2011), pp. 930-936
[4]
A.D. Frolkis, J. Dykeman, M.E. Negrón, J. Debruyn, N. Jette, K.M. Fiest, et al.
Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies.
Gastroenterology., 145 (2013), pp. 996-1006
[5]
I. Vind, L. Riis, T. Jess, E. Knudsen, N. Pedersen, M. Elkjaer, et al.
Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003-2005: a population-based study from the Danish Crohn colitis database.
Am J Gastroenterol., 101 (2016), pp. 1274-1282
[6]
C.N. Bernstein, A. Nabalamba.
Hospitalization, surgery, and readmission rates of IBD in Canada: a population-based study.
Am J Gastroenterol., 101 (2006), pp. 110-118
[7]
F. Schnitzler, H. Fidder, M. Ferrante, M. Noman, I. Arijs, G. Van Assche, et al.
Long-term outcome of treatment with infliximab in 614 patients with Crohn's disease: results from a single-centre cohort.
Gut., 58 (2009), pp. 492-500
[8]
R.R. Cannom, A.M. Kaiser, G.T. Ault, R.W. Beart Jr., D.A. Etzioni.
Inflammatory bowel disease in the United States from 1998 to 2005: has infliximab affected surgical rates?.
Am Surg., 75 (2009), pp. 976-980
[9]
M. Lazarev, T. Ullman, W.H. Schraut, K.E. Kip, M. Saul, M. Regueiro.
Small bowel resection rates in Crohn's disease and the indication for surgery over time: experience from a large tertiary care center.
Inflamm Bowel Dis., 16 (2010), pp. 830-835
[10]
D.W. Jones, S.R. Finlayson.
Trends in surgery for Crohn's disease in the era of infliximab.
Ann Surg., 252 (2010), pp. 307-312
[11]
J. Panes, Y. Bouhnik, W. Reinisch, J. Stoker, S.A. Taylor, D.C. Baumgart, et al.
Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines.
J Crohns Colitis., 7 (2013), pp. 556-585
[12]
J. Panes, R. Bouzas, M. Chaparro, V. Garcia-Sanchez, J.P. Gisbert, B. Martinez de Guerenu, et al.
Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease.
Aliment Pharmacol Ther., 34 (2011), pp. 125-145
[13]
M. Fraquelli, A. Sarno, C. Girelli, C. Laudi, E. Buscarini, C. Villa, et al.
Reproducibility of bowel ultrasonography in the evaluation of Crohn's disease.
Dig Liver Dis., 40 (2008), pp. 860-866
[14]
K. Nylund, T. Hausken, O.H. Gilja.
Ultrasound and inflammatory bowel disease.
Ultrasound Q., 26 (2010), pp. 3-15
[15]
L.M. Minordi, A. Vecchioli, P. Mirk, L. Bonomo.
CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease.
Br J Radiol., 84 (2011), pp. 112-119
[16]
G. Fiorino, C. Bonifacio, L. Peyrin-Biroulet, F. Minuti, A. Repici, A. Spinelli, et al.
Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn's disease.
Inflamm Bowel Dis., 17 (2011), pp. 1073-1080
[17]
H. Lochs, C. Dejong, F. Hammarqvist, X. Hebuterne, M. Leon-Sanz, T. Schutz, et al.
ESPEN Guidelines on Enteral Nutrition: Gastroenterology.
Clin Nutr., 25 (2006), pp. 260-274
[18]
W. Huang, Y. Tang, L. Nong, Y. Sun.
Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn's disease: A meta-analysis of observational studies.
J Crohns Colitis., 9 (2015), pp. 293-301
[19]
K.D. Lindor, C.R. Fleming, D.M. Ilstrup.
Preoperative nutritional status and other factors that influence surgical outcome in patients with Crohn's disease.
Mayo Clin Proc., 60 (1985), pp. 393-396
[20]
T. Yamamoto, R.N. Allan, M.R. Keighley.
Risk factors for intra-abdominal sepsis after surgery in Crohn's disease.
Dis Colon Rectum., 43 (2000), pp. 1141-1145
[21]
A. Alves, Y. Panis, Y. Bouhnik, M. Pocard, E. Vicaut, P. Valleur.
Risk factors for intra-abdominal septic complications after a first ileocecal resection for Crohn's disease: a multivariate analysis in 161 consecutive patients.
Dis Colon Rectum., 50 (2007), pp. 331-336
[22]
J. Gibbs, W. Cull, W. Henderson, J. Daley, K. Hur, S.F. Khuri.
Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study.
Arch. Surg., 134 (1999), pp. 36-42
[23]
P.S. Morar, J.D. Hodgkinson, S. Thalayasingam, K. Koysomat, M. Purcell, A.L. Hart, et al.
Determining predictors for intra-abdominal septic complications following ileocolonic resection for Crohn's disease-considerations in pre-operative and peri-operative optimisation techniques to improve outcome.
J Crohns Colitis., 9 (2015), pp. 483-491
[24]
H. Wang, L. Zuo, J. Zhao, J. Dong, Y. Li, L. Gu, J. Gong, Q. Liu, W. Zhu.
Impact of Preoperative Exclusive Enteral Nutrition on Postoperative Complications and Recurrence After Bowel Resection in Patients with Active Crohn's Disease.
World J Surg., 40 (2016), pp. 1993-2000
[25]
S. Jacobson.
Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition.
Scand J Gastroenterol., 47 (2012), pp. 170-177
[26]
P. Zerbib, D. Koriche, S. Truant, A.F. Bouras, G. Vernier-Massouille, D. Seguy, et al.
Pre-operative management is associated with low rate of post-operative morbidity in penetrating Crohn's disease.
Alimen. Pharmacol Ther., 32 (2010), pp. 459-465
[27]
G. Li, J. Ren, G. Wang, D. Hu, G. Gu, S. Liu, et al.
Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn's disease.
Eur J Clin Nutr., 68 (2014), pp. 441-446
[28]
D. Hu, J. Ren, G. Wang, G. Li, S. Liu, D. Yan, et al.
Exclusive enteral nutritional therapy can relieve inflammatory bowel stricture in Crohn's disease.
J Clin Gastroenterol., 48 (2014 Oct), pp. 790-795
[29]
J.L. Rombeau, L.R. Barot, C.E. Williamson, J.L. Mullen.
Preoperative total parenteral nutrition and surgical outcome in patients with inflammatory bowel disease.
Am J Surg., 143 (1982), pp. 139-143
[30]
F.N. Aberra, J.D. Lewis, D. Hass, J.L. Rombeau, B. Osborne, G.R. Lichtenstein.
Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients.
Gastroenterology., 125 (2003), pp. 320-327
[31]
A. Tzivanakis, J.C. Singh, R.J. Guy, S.P. Travis, N.J. Mortensen, B.D. George.
Influence of risk factors on the safety of ileocolic anastomosis in Crohn's disease surgery.
Dis Colon Rectum., 55 (2012), pp. 558-562
[32]
W.A. Bemelman, J. Warusavitarne, G.M. Sampietro, Z. Serclova, O. Zmora, G. Luglio, et al.
ECCO-ESCP Consensus on Surgery for Crohn's Disease.
J Crohn's Colitis., 12 (2018), pp. 1-16
[33]
V. Billioud, A.C. Ford, E.D. Tedesco, J.F. Colombel, X. Roblin, L. Peyrin-Biroulet.
Preoperative use of anti-TNF therapy and postoperative complications in inflammatory bowel diseases: a meta-analysis.
J Crohns Colitis, 7 (2013), pp. 853-867
[34]
A. De Buck van Overstraeten, E.J. Eshuis, S. Vermeire, G. Van Assche, M. Ferrante, G.R. D’Haens, et al.
Short- and medium-term outcomes following primary ileocaecal resection for Crohn's disease in two specialist centres.
Br J Surg., 104 (2017), pp. 1713-1722
[35]
T. Yamamoto, A. Spinelli, Y. Suzuki, R. Saad-Hossne, F.V. Teixeira, I.C. de Albuquerque, et al.
Risk factors for complications after ileocolonic resection for Crohn's disease with a major focus on the impact of preoperative immunosuppressive and biologic therapy: A retrospective international multicentre study.
United European Gastroenterol J., 4 (2016), pp. 784-793
[36]
P.G. Kotze, M.P. Saab, B. Saab, L.M. da Silva Kotze, M. Olandoski, L.V. Pinheiro, et al.
Tumor Necrosis Factor Alpha Inhibitors Did Not Influence Postoperative Morbidity After Elective Surgical Resections in Crohn's Disease.
Dig Dis Sci., 62 (2017), pp. 456-464
[37]
P.G. Kotze, D.O. Magro, C.A.R. Martinez, B. Saab, M.P. Saab, L.V. Pinheiro, et al.
Adalimumab and postoperative complications of elective intestinal resections in Crohn's disease: a propensity score case-matched study.
Colorectal Dis., (2017),
[38]
C. Lau, M. Dubinsky, G. Melmed, E. Vasiliauskas, D. Berel, D. McGovern, et al.
The impact of preoperative serum anti=TNF therapy levels on early postoperative outcomes in inflammatory bowel disease surgery.
Ann Surg., 261 (2015), pp. 487-496
[39]
C.N. Bernstein, J.F. Blanchard, D.S. Houston, A. Wajda.
The incidence of deep venous thrombosis and pulmonary embolism among patients with inflammatory bowel disease: a population based cohort study.
Thromb Haemost, 85 (2001), pp. 430-434
[40]
S. Danese, A. Papa, S. Saibeni, A. Repici, A. Malesci, M. Vecchi.
Inflammation and coagulation in inflammatory bowel disease: the clot thickens.
Am J Gastroenterol., 102 (2007), pp. 174-186
[41]
M.R. Imbrizzi, D.O. Magro, T.M.L. Secundo, M. Cunha-Silva, P.G. Kotze, C.G. Montes, et al.
Hypoalbuminemia as a risk factor for thromboembolic events in inflammatory bowel disease patients.
Intest Res., 17 (2019), pp. 63-69
[42]
A. Merrill, F. Millham.
Increased risk of postoperative deep vein thrombosis and pulmonary embolism in patients with inflammatory bowel disease: a study of National Surgical Quality Improvement Program patients.
Arch Surg, 147 (2012), pp. 120-124
[43]
F. Bellolio, Z. Cohen, H.M. MacRae, B.I. O’Connor, J.C. Victor, H. Huang, et al.
Strictureplasty in selected Crohn's disease patients results in acceptable long-term outcome.
Dis Colon Rectum., 55 (2012), pp. 864-869
[44]
F. Michelassi, D. Mege, M. Rubin, R.D. Hurst.
Long-term results of the side-to-side isoperistaltic strictureplasty in Crohn's disease: 25-year follow-up and outcomes.
[45]
S. Strong, S.R. Steele, M. Boutrous, L. Bordineau, J. Chun, D.B. Stewart, et al.
Clinical Practice Guidelines Committee of the American Society of Colon and Rectal Surgeons Clinical Practice Guideline for the Surgical Management of Crohn's Disease.
Dis Colon Rectum., 58 (2015), pp. 1021-1036
[46]
P.Y. Choy, I.P. Bissett, J.G. Docherty, B.R. Parry, A. Merrie, A. Fitzgerald.
Stapled versus handsewn methods for ileocolic anastomoses.
Cochrane Database Syst. Rev., (2011),
[47]
C.J. Coffey, M.G. Kiernan, S.M. Sahebally, A. Jarrar, J.P. Burke, P.A. Kiely, et al.
Inclusion of the Mesentery in Ileocolic Resection for Crohn's Disease Is Associated With Reduced Surgical Recurrence.
J Crohns Colitis., 12 (2018), pp. 1139-1150
[48]
P.P. Tekkis, S. Purkayastha, S. Lanitis, T. Athanasiou, A.G. Heriot, T.R. Orchard, et al.
A comparison of segmental vs subtotal/total colectomy for colonic Crohn's disease: a meta-analysis.
Colorectal Dis., 8 (2006), pp. 82-90
[49]
P. Kotze, V. Abou-Rejaile, I. De Barcelos, E. Miranda, J. Martins, J. Rocha, et al.
Complication rates after bowel resections for crohn's disease: A brazilian single-center comparison between laparoscopic and conventional surgery.
Inflamm Bowel Dis., 18 (2012), pp. S58-S59
[50]
L. Maggiori, Y. Panis.
Surgical management of IBD — from an open to a laparoscopic approach.
Nat Publ Gr, 10 (2013), pp. 297-306
[51]
L. Stocchi, J.W. Milsom, V.W. Fazio.
Long-term outcomes of laparoscopic versus open ileocolic resection for Crohn's disease: follow-up of a prospective randomized trial.
Surgery., 144 (2008), pp. 622-627
[52]
P. Rutgeerts, K. Geboes, G. Vantrappen, J. Beyls, R. Kerremans, M. Hiele.
Predictability of the postoperative course of Crohn's disease.
Gastroenterology., 99 (1990), pp. 956-963
[53]
J.P. Terdiman.
Prevention of postoperative recurrence in Crohn's disease.
Clin Gastroenterol Hepatol., 6 (2008), pp. 616-620
[54]
A. Buisson, J.-B. Chevaux, P.B. Allen, G. Bommelaer, L. Peyrin-Biroulet.
Review article: the natural history of postoperative Crohn's disease recurrence.
Aliment Pharmacol Ther., 35 (2012), pp. 625-633
[55]
S.B. Hanauer, B.I. Korelitz, P. Rutgeerts, M.A. Peppercorn, R.A. Thisted, R.D. Cohen, et al.
Postoperative maintenance of Crohn's disease remission with 6-mercaptopurine, mesalamine, or placebo: a 2-year trial.
Gastroenterology., 127 (2004), pp. 723-729
[56]
C. Mowat, I. Arnott, A. Cahill, M. Smith, T. Ahmad, S. Subramanian, et al.
Mercaptopurine versus placebo to prevent recurrence of Crohn's disease after surgical resection (TOPPIC): a multicentre, double-blind, randomised controlled trial.
Lancet Gastroenterol Hepatol., 1 (2016), pp. 273-282
[57]
M. Regueiro, W. Schraut, L. Baidoo, K.E. Kip, A.R. Sepulveda, M. Pesci, et al.
Infliximab prevents Crohn's disease recurrence after ileal resection.
Gastroenterology., 136 (2009), pp. 441-450
[58]
T. Yamamoto, S. Umegae, K. Matsumoto.
Impact of infliximab therapy after early endoscopic recurrence following ileocolonic resection of Crohn's disease: a prospective pilot study.
Inflamm Bowel Dis., 15 (2009), pp. 1460-1466
[59]
Y. Qiu, R. Mao, B.L. Chen, Y. He, Z.R. Zeng, M.H. Chen.
Systematic review with meta-analysis of prospective studies: anti-tumour necrosis factor for prevention of postoperative Crohn's disease recurrence.
J Crohns Colitis., 9 (2015), pp. 918-927
[60]
M. Regueiro, B.G. Feagan, B. Zou, J. Johanns, M.A. Blank, M. Chevrier, et al.
Infliximab reduces endoscopic, but not clinical, recurrence of Crohn's disease after ileocolonic resection.
Gastroenterology., 150 (2016), pp. 1568-1578
[61]
P.G. Kotze, T. Yamamoto, A.O.M.C. Damiao.
Postoperative Approach for Crohn's Disease: The Right Therapy to the Right Patient.
Curr Drug Targets., 19 (2018), pp. 729-739
Opciones de artículo
Herramientas
es en pt
Política de cookies Cookies policy Política de cookies
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.