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1.
BMC Surg ; 24(1): 130, 2024 May 03.
Artículo en Inglés | MEDLINE | ID: mdl-38698365

RESUMEN

BACKGROUND: Anastomosis configuration is an essential step in treatment to restore continuity of the gastrointestinal tract following bowel resection in patients with Crohn's disease (CD). However, the association between anastomotic type and surgical outcome remains controversial. This retrospective study aimed to compare early postoperative complications and surgical outcome between stapler and handsewn anastomosis after bowel resection in Crohn's disease. METHODS: Between 2001 and 2018, a total of 339 CD patients underwent bowel resection with anastomosis. Patient characteristics, intraoperative data, early postoperative complications, and outcomes were analyzed and compared between two groups of patients. Group 1 consisted of patients with stapler anastomosis and group 2 with handsewn anastomosis. RESULTS: No significant difference was found in the incidence of postoperative surgical complications between the stapler and handsewn anastomosis groups (25% versus 24.4%, p = 1.000). Reoperation for complications and postoperative hospital stay were similar between the two groups. CONCLUSION: Our analysis showed that there were no differences in anastomotic leak, nor postoperative complications, mortality, reoperation for operative complications, or postoperative hospital stay between the stapler anastomosis and handsewn anastomosis groups.


Asunto(s)
Anastomosis Quirúrgica , Enfermedad de Crohn , Complicaciones Posoperatorias , Grapado Quirúrgico , Humanos , Enfermedad de Crohn/cirugía , Femenino , Masculino , Anastomosis Quirúrgica/métodos , Estudios Retrospectivos , Adulto , Grapado Quirúrgico/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Persona de Mediana Edad , Técnicas de Sutura , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Tiempo de Internación/estadística & datos numéricos , Fuga Anastomótica/epidemiología , Fuga Anastomótica/etiología , Adulto Joven
3.
Sci Rep ; 14(1): 10823, 2024 05 11.
Artículo en Inglés | MEDLINE | ID: mdl-38734721

RESUMEN

Postoperative disease recurrence in Crohn's disease represents a relevant issue despite recent advancements in surgical and medical therapies. Additional criteria are necessary to improve the identification of patients at risk and to enable selective therapeutic approaches. The role of resection margins on disease recurrence remains unclear and general recommendations are lacking. A single-center retrospective analysis was performed including all patients who received ileocecal resection due to Crohn's disease. Resection margins were analyzed by two independent pathologists and defined by histopathological criteria based on previous consensus reports. 158 patients were included for analysis with a median follow up of 35 months. While postoperative morbidity was not affected, positive resection margins resulted in significantly increased rates of severe endoscopic recurrence at 6 months (2.0% versus 15.6%, p = 0.02) and overall (4.2% versus 19.6%, p = 0.001), which resulted in significantly increased numbers of surgical recurrence (0% versus 4.5%, p = 0.04). Additionally, positive margins were identified as independent risk factor for severe endoscopic disease recurrence in a multivariate analysis. Based on that, positive margins represent an independent risk factor for postoperative endoscopic and surgical disease recurrence. Prospective studies are required to determine whether extended resection or postoperative medical prophylaxis is beneficial for patients with positive resection margins.


Asunto(s)
Enfermedad de Crohn , Márgenes de Escisión , Recurrencia , Humanos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/patología , Masculino , Femenino , Adulto , Factores de Riesgo , Estudios Retrospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Adulto Joven , Anciano , Periodo Posoperatorio
4.
BMJ Open Gastroenterol ; 11(1)2024 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-38777566

RESUMEN

OBJECTIVE: It is unclear whether widespread use of biologics is reducing inflammatory bowel disease (IBD) surgical resection rates. We designed a population-based study evaluating the impact of early antitumour necrosis factor (TNF) on surgical resection rates up to 5 years from diagnosis. DESIGN: We evaluated all patients with IBD diagnosed in Cardiff, Wales 2005-2016. The primary measure was the impact of early (within 1 year of diagnosis) sustained (at least 3 months) anti-TNF compared with no therapy on surgical resection rates. Baseline factors were used to balance groups by propensity scores, with inverse probability of treatment weighting (IPTW) methodology and removing immortal time bias. Crohn's disease (CD) and ulcerative colitis (UC) with IBD unclassified (IBD-U) (excluding those with proctitis) were analysed. RESULTS: 1250 patients were studied. For CD, early sustained anti-TNF therapy was associated with a reduced likelihood of resection compared with no treatment (IPTW HR 0.29 (95% CI 0.13 to 0.65), p=0.003). In UC including IBD-U (excluding proctitis), there was an increase in the risk of colectomy for the early sustained anti-TNF group compared with no treatment (IPTW HR 4.6 (95% CI 1.9 to 10), p=0.001). CONCLUSIONS: Early sustained use of anti-TNF therapy is associated with reduced surgical resection rates in CD, but not in UC where there was a paradoxical increased surgery rate. This was because baseline clinical factors were less predictive of colectomy than anti-TNF usage. These data support the use of early introduction of anti-TNF therapy in CD whereas benefit in UC cannot be assessed by this methodology.


Asunto(s)
Colectomía , Colitis Ulcerosa , Enfermedad de Crohn , Factor de Necrosis Tumoral alfa , Humanos , Masculino , Femenino , Adulto , Colectomía/estadística & datos numéricos , Colectomía/métodos , Persona de Mediana Edad , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/epidemiología , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/cirugía , Colitis Ulcerosa/epidemiología , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/cirugía , Infliximab/uso terapéutico , Adulto Joven , Resultado del Tratamiento , Estudios Retrospectivos , Anciano , Puntaje de Propensión , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico
6.
Aliment Pharmacol Ther ; 59(12): 1579-1588, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38616417

RESUMEN

BACKGROUND: Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course. AIM: To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD. METHODS: We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation. RESULTS: Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR: 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively. CONCLUSION: Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.


Asunto(s)
Enfermedad de Crohn , Reoperación , Humanos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Masculino , Reoperación/estadística & datos numéricos , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Inmunosupresores/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Cuidados Posoperatorios/métodos , Adulto Joven , Estimación de Kaplan-Meier , Factores de Tiempo , Modelos de Riesgos Proporcionales
7.
Acta Cir Bras ; 39: e391924, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38629651

RESUMEN

PURPOSE: To evaluate patient characteristics and factors associated with surgical resection in patients with Crohn's disease (CD). METHODS: An analysis was performed on data from 295 patients with CD in follow-up from 2001 to 2018. Medical record data comprised age, gender, location, behavior and duration of the CD, smoking, and extraintestinal manifestation. Patients were divided into two groups according to the presence or absence of surgical resection. RESULTS: Out of the 295 patients with CD, 155 underwent surgical resection (53.2% male, mean age: 43.88 ± 14.35 years). The main indications for surgery were stenosis (44.5%), clinical intractability (15.5%), and intra-abdominal fistulas (15.5%). Smoking (p < 0.001), longer CD duration (p < 0.0001), ileo-colonic location (p = 0.003), stenosing behavior (p < 0.0001), and fistulizing behavior (p < 0.0001) were significantly associated with surgical resection. Initial use of biological was significantly more frequent in the group of patients without surgical resection (p < 0.001). CONCLUSIONS: Patients with CD still frequently need surgical treatment. Smoking (current or past), longer disease time, stenosing and fistulizing behavior, and ileo-colonic localization in CD patients were associated with a higher risk of surgery. Awareness about factors associated with unfavorable outcome allows such patients to be treated more appropriately.


Asunto(s)
Enfermedad de Crohn , Humanos , Masculino , Adulto , Persona de Mediana Edad , Femenino , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/cirugía , Íleon , Estudios Retrospectivos
8.
Langenbecks Arch Surg ; 409(1): 132, 2024 Apr 19.
Artículo en Inglés | MEDLINE | ID: mdl-38639899

RESUMEN

BACKGROUND: Operative options for duodenal Crohn's disease include bypass, stricturoplasty, or resection. What factors are associated with operation selection and whether differences exist in outcomes is unknown. METHODS: Patients with duodenal Crohn's disease requiring operative intervention across a multi-state health system were identified. Patient and operative characteristics, short-term surgical outcomes, and the need for future endoscopic or surgical management of duodenal Crohn's disease were analyzed. RESULTS: 40 patients underwent bypass (n = 26), stricturoplasty (n = 8), or resection (n = 6). Median age of diagnosis of Crohn's disease was 23.5 years, and over half of the patients had undergone prior surgery for CD. Operation type varied by the most proximal extent of duodenal involvement. Patients with proximal duodenal CD underwent bypass operations more commonly than those with mid- or distal duodenal disease (p = 0.03). Patients who underwent duodenal stricturoplasty more often required concomitant operations for other sites of small bowel or colonic CD (63%) compared to those who underwent bypass (39%) or resection (33%). No patients required subsequent surgery for duodenal CD at a median follow-up of 2.8 years, but two patients required endoscopic dilation (n = 1 after stricturoplasty, n = 1 after resection). CONCLUSION: Patients who require surgery for duodenal Crohn's disease appear to have an aggressive Crohn's disease phenotype, represented by a younger age of diagnosis and a high rate of prior resection for Crohn's disease. Choice of operation varied by proximal extent of duodenal Crohn's disease.


Asunto(s)
Enfermedad de Crohn , Enfermedades Duodenales , Humanos , Adulto Joven , Adulto , Enfermedad de Crohn/cirugía , Enfermedades Duodenales/cirugía , Enfermedades Duodenales/complicaciones , Duodeno/cirugía , Intestino Delgado , Colon
9.
Am J Clin Nutr ; 119(4): 1027-1035, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38569774

RESUMEN

BACKGROUND: The postoperative inflammatory response is associated with postoperative recovery in surgery. n-3 (ω-3) polyunsaturated fatty acids have been reported to lower inflammation. The postoperative role of parenteral n-3 polyunsaturated fatty acids supplementation on outcomes in Crohn's disease after bowel resection is unclear. OBJECTIVES: We aimed to investigate the effects of postoperative parenteral n-3 polyunsaturated fatty acids supplementation in Crohn's disease. METHODS: A prospective randomized, unblinded controlled clinical trial was conducted for patients with Crohn's disease who underwent bowel resection between May 2019 and February 2022. Postoperative complications, complete blood count, serum biochemical values, and cytokine concentrations were compared in patients with and without parenteral n-3 polyunsaturated fatty acids supplementation for 5 d postoperatively. RESULTS: There were 268 patients randomly assigned in the analysis, with 134 in the control group (a mix of long-chain and medium-chain fats at 1.0 g/kg/d) and 134 in the treatment group (long-chain, medium-chain, and n-3 polyunsaturated fats at 1.2 g/kg/d). Twenty-six did not complete the allocated treatment, and 8 patients were lost to follow-up. The intention-to-treat analysis and the per-protocol analysis showed that there were a significant reduction in overall complication rates (22.4% compared with 49.3%; P < 0.001 and 21.8% compared with 38.2%; P = 0.006) and postoperative stay (8.8 ± 4.5 d compared with 11.2 ± 6.8 d; P = 0.001 and 8.7 ± 4.0 d compared with 11.5 ± 7.3 d; P < 0.001) in patients with parenteral n-3 polyunsaturated fatty acids supplementation compared with patients in the control group. In the secondary outcomes, the mean ± standard deviation of interleukin (IL)-6 (17.11 ± 2.14 pg/mL compared with 30.50 ± 5.14 pg/mL; P = 0.014), IL-1ß (2.01 ± 0.05 pg/mL compared with 2.24 ± 0.09 pg/mL; P = 0.019), tumor necrosis factor-α (2.09 ± 0.06 pg/mL compared with 2.29 ± 0.06 pg/mL; P = 0.029), and C-reactive protein concentrations (51.3 ± 4.2 mg/L compared with 64.4 ± 5.3 mg/L; P = 0.050) on postoperative day 5 in the treatment group were much lower than those in the control group. CONCLUSIONS: Parenteral n-3 polyunsaturated fatty acids supplementation promotes postoperative recovery in patients with Crohn's disease following bowel resection, with fewer complications and reduced inflammatory cytokines. This trial was registered at clinicaltrials.gov as NCT03901937 at https://classic. CLINICALTRIALS: gov/ct2/show/NCT03901937?term=NCT03901937&cond=Crohn+Disease&draw=2&rank=1.


Asunto(s)
Enfermedad de Crohn , Ácidos Grasos Omega-3 , Humanos , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/cirugía , Estudios Prospectivos , Ácidos Grasos Omega-3/uso terapéutico , Nutrición Parenteral , Citocinas , Interleucina-6 , Suplementos Dietéticos
10.
Int J Colorectal Dis ; 39(1): 58, 2024 Apr 25.
Artículo en Inglés | MEDLINE | ID: mdl-38661931

RESUMEN

PURPOSE: Inflammatory bowel disease (IBD) in childhood often presents with a more extensive and more aggressive disease course than adult-onset disease. We aimed to evaluate if biological treatment started in childhood decreases the need for intestinal surgery over time. METHODS: This was a retrospective, single-center, cohort study. All pediatric patients with IBD initiated to biological therapy at the Children's Hospital, were included in the study and followed up to the first surgical procedure or re-operation in their adulthood or until 31.12.2021 when ≥ 18 of age. Data were collected from the pediatric registry of IBD patients with biologicals and medical charts. RESULTS: A total of 207 pediatric IBD patients were identified [150 with Crohn´s disease (CD), 31 with ulcerative colitis (UC), 26 with IBD unclassified (IBDU)] of which 32.9% (n = 68; CD 49, UC 13, IBDU 6) underwent intestinal surgery. At the end of a median follow-up of 9.0 years (range 2.0-25.9), patients reached a median age of 21.4 years (range 18-36). Patients who had intestinal surgery in childhood were more likely to have IBD-related surgery also in early adulthood. The duration of the disease at induction of the first biological treatment emerged as the only risk factor, with a longer duration in the surgical group than in patients with no surgery. CONCLUSION: Despite initiation of biological treatment, the risk of intestinal surgery remains high in pediatric IBD patients and often the need for surgery emerges after the transition to adult IBD clinics.


Asunto(s)
Productos Biológicos , Enfermedades Inflamatorias del Intestino , Humanos , Masculino , Femenino , Adolescente , Niño , Adulto Joven , Productos Biológicos/uso terapéutico , Adulto , Enfermedades Inflamatorias del Intestino/cirugía , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Estudios Retrospectivos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/tratamiento farmacológico , Colitis Ulcerosa/cirugía , Colitis Ulcerosa/tratamiento farmacológico , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Preescolar
11.
Semin Pediatr Surg ; 33(2): 151403, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38593515

RESUMEN

Although surgical management of the ileocolic segment in pediatric Crohn's disease is not curative, the main goal of therapy is to allow for growth, adequate nutrition, and age-appropriate development. Recurrent disease at the site of anastomosis presents as a major morbidity. Several factors have been implicated in the development of surgical recurrence though data in the literature is scarce. This review explores the epidemiology of recurrent ileocolic disease following primary surgery, indications for surgical intervention, and techniques reported in the literature. Pediatric data is scarce, and therefore, much of it is extrapolated from adult literature.


Asunto(s)
Enfermedad de Crohn , Recurrencia , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/terapia , Enfermedad de Crohn/patología , Humanos , Niño , Factores de Riesgo , Anastomosis Quirúrgica/métodos
12.
Semin Pediatr Surg ; 33(2): 151401, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38615423

RESUMEN

Management of pediatric-onset Crohn's disease uniquely necessitates consideration of growth, pubertal development, psychosocial function and an increased risk for multiple future surgical interventions. Both medical and surgical management are rapidly advancing; therefore, it is increasingly important to define the role of surgery and the breadth of surgical options available for this complex patient population. Particularly, the introduction of biologics has altered the disease course; however, the ultimate need for surgical intervention has remained unchanged. This review defines and evaluates the surgical techniques available for management of the most common phenotypes of pediatric-onset Crohn's disease as well as identifies critical perioperative considerations for optimizing post-surgical outcomes.


Asunto(s)
Enfermedad de Crohn , Humanos , Enfermedad de Crohn/cirugía , Niño , Procedimientos Quirúrgicos del Sistema Digestivo/métodos
13.
Semin Pediatr Surg ; 33(2): 151399, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38642531

RESUMEN

Surgical management of pediatric Crohn's disease is fundamentally palliative, aiming to treat the sequalae of complicated disease while preserving intestinal length. Multidisciplinary discussion of risk factors and quality of life should take place prior to operative intervention. Though the surgical management of pediatric Crohn's disease is largely based on the adult literature, there are considerations specific to the pediatric population - notably disease and treatment effects on growth and development. Intrabdominal abscess is approached with percutaneous drainage when feasible, reserving surgical intervention for the patient who is unstable or failing medical therapy. Pediatric patients with fibrostenotic disease should be considered for strictureplasty when possible, for maximum preservation of bowel length. Patients with medically refractory Crohn's proctocolitis should be treated initially with fecal diversion without proctocolectomy.


Asunto(s)
Enfermedad de Crohn , Humanos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/complicaciones , Niño , Absceso Abdominal/cirugía , Absceso Abdominal/etiología , Drenaje/métodos
14.
Dis Colon Rectum ; 67(S1): S70-S81, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38441126

RESUMEN

BACKGROUND: Radiographic imaging of the abdomen and pelvis plays an important role in the diagnosis and management of ileal pouch disorders with modalities including CT, MRI, contrasted pouchography, and defecography. OBJECTIVES: To perform a systematic review of the literature and describe applications of cross-sectional imaging, pouchography, defecography, and ultrasonography. DATA SOURCES: PubMed, Google Scholar, and Cochrane database. STUDY SELECTION: Relevant articles on endoscopy in ileal pouches published between January 2003 and June 2023 in English were included on the basis of Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. INTERVENTION: Main abdominal and pelvic imaging modalities and their applications in the diagnosis of ileal pouch disorders were included. MAIN OUTCOME MEASURES: Accuracy in characterization of ileal pouch disorders. RESULTS: CT is the test of choice for the evaluation of acute anastomotic leaks, perforation, and abscess(es). MRI of the pelvis is suitable for the assessment of chronic anastomotic leaks and their associated fistulas and sinus tracts, as well as for the penetrating phenotype of Crohn's disease of the pouch. CT enterography and magnetic resonance enterography are useful in assessing intraluminal, intramural, and extraluminal disease processes of the pouch and prepouch ileum. Water-soluble contrast pouchography is particularly useful for evaluating acute or chronic anastomotic leaks and outlines the shape and configuration of the pouch. Defecography is the key modality to evaluate structural and functional pouch inlet and outlet obstructions. Ultrasonography can be performed to assess the pouch in experienced IBD centers. LIMITATIONS: This is a qualitative, not quantitative, review of mainly case series and case reports. CONCLUSIONS: Abdominopelvic imaging, along with clinical and endoscopic evaluation, is imperative for accurately assessing structural, inflammatory, functional, and neoplastic disorders. See video from symposium .


Asunto(s)
Reservorios Cólicos , Imagen por Resonancia Magnética , Humanos , Reservorios Cólicos/efectos adversos , Imagen por Resonancia Magnética/métodos , Proctocolectomía Restauradora/efectos adversos , Proctocolectomía Restauradora/métodos , Defecografía/métodos , Ultrasonografía/métodos , Tomografía Computarizada por Rayos X/métodos , Reservoritis/diagnóstico por imagen , Reservoritis/diagnóstico , Reservoritis/etiología , Fuga Anastomótica/diagnóstico por imagen , Fuga Anastomótica/etiología , Fuga Anastomótica/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Enfermedad de Crohn/diagnóstico por imagen , Enfermedad de Crohn/cirugía
15.
Tech Coloproctol ; 28(1): 40, 2024 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-38507096

RESUMEN

BACKGROUND: Resection and strictureplasty are the two surgical modalities used in the management of Crohn's disease (CD). The objective of this study was to compare morbidity and clinical recurrence between patients who underwent strictureplasty and patients who underwent resection. METHODS: Patients with CD who underwent strictureplasty between January 2012 and December 2022 were enrolled. The patients were well matched with patients who underwent resection without strictureplasty. Patient- and disease-specific characteristics, postoperative morbidity, and clinical recurrence were also analyzed. RESULTS: A total of 118 patients who underwent a total of 192 strictureplasties were well matched to 118 patients who underwent resection. The strictureplasty group exhibited significantly less blood loss (30 ml versus 50 ml, p < 0.001) and stoma creation (2.5% versus 16.9%, p < 0.001). No significant difference was found regarding postoperative complications or length of postoperative stay. At the end of the follow-up, the overall rate of clinical recurrence was 39.4%, and no difference was observed between the two groups. Postoperative prophylactic use of biologics (odds ratio = 0.2, p < 0.001) was the only protective factor against recurrence. CONCLUSION: Strictureplasty does not increase the risk of complications or recurrence compared with resection. It represents a viable alternative to resection in selected patients, and as such, it should have a broader scope of indications and greater acceptance among surgeons.


Asunto(s)
Enfermedad de Crohn , Humanos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/complicaciones , Recurrencia , Reoperación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento
16.
Int J Colorectal Dis ; 39(1): 36, 2024 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-38456914

RESUMEN

INTRODUCTION: Crohn's disease (CD) is a chronic inflammatory bowel disease of a multifactorial pathogenesis. Recently numerous genetic variants linked to an aggressive phenotype were identified, leading to a progress in therapeutic options, resulting in a decreased necessity for surgery. Nevertheless, surgery is often inevitable. The aim of the study was to evaluate possible risk factors for postoperative complications and disease recurrence specifically after colonic resections for CD. PATIENTS AND METHODS: A total of 241 patients who underwent colonic and ileocaecal resections for CD at our instiution between 2008 and 2018 were included. All data was extracted from clinical charts. RESULTS: Major complications occurred in 23.8% of all patients. Patients after colonic resections showed a significantly higher rate of major postoperative complications compared to patients after ICR (p = < 0.0001). The most common complications after colonic resections were postoperative bleeding (22.2%), the need for revision surgery (27.4%) and ICU (17.2%) or hospital readmission (15%). As risk factors for the latter, we identified time interval between admission and surgery (p = 0.015) and the duration of the surgery (p = 0.001). Isolated distal resections had a higher risk for revision surgery and a secondary stoma (p = 0.019). Within the total study population, previous bowel resections (p = 0.037) were identified as independent risk factors for major perioperative complications. CONCLUSION: The results indicate that both a complex surgical site and a complex surgical procedure lead to a higher perioperative morbidity in colonic resections for Crohn's colitis.


Asunto(s)
Colitis , Enfermedad de Crohn , Humanos , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/patología , Colectomía/efectos adversos , Colectomía/métodos , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias/epidemiología , Colitis/cirugía , Colitis/complicaciones , Morbilidad
18.
J Gastroenterol ; 59(5): 389-401, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38492011

RESUMEN

BACKGROUND: Corticosteroids are recommended only for induction of remission in inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). This study aimed to evaluate the change in pharmacologic treatment use, particularly systemic corticosteroids, over approximately 30 years, and the impact of biologics on IBD treatment since their appearance in the 2000s. METHODS: This retrospective study conducted in Japan used data from the Phoenix cohort database (January 1990 to March 2021). Patients with disease onset at age ≥ 10 years who received treatment for UC or CD between January 1990 and March 2021 were included. Outcome measures were change in IBD treatments used, total cumulative corticosteroid doses, initial corticosteroid dose, duration of corticosteroid treatment, and surgery rate. RESULTS: A total of 1066 and 579 patients with UC and CD, respectively, were included. In UC, the rate of corticosteroid use as initial treatment was relatively stable regardless of the year of disease onset; however, in CD, its rate decreased in patients who had disease onset after 2006 (before 2006: 14.3-27.8% vs. after 2006: 6.6-10.5%). Compared with patients with disease onset before biologics became available, cumulative corticosteroid doses in both UC and CD, and the surgery rate in CD only, were lower in those with disease onset after biologics became available. CONCLUSIONS: Since biologics became available, corticosteroid use appears to have decreased, with more appropriate use. Furthermore, use of biologics may reduce surgery rates, particularly in patients with CD. UMIN Clinical Trials Registry; UMIN000035384.


Asunto(s)
Productos Biológicos , Colitis Ulcerosa , Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Humanos , Niño , Japón , Estudios Retrospectivos , Enfermedades Inflamatorias del Intestino/tratamiento farmacológico , Enfermedades Inflamatorias del Intestino/cirugía , Colitis Ulcerosa/tratamiento farmacológico , Colitis Ulcerosa/cirugía , Enfermedad de Crohn/tratamiento farmacológico , Enfermedad de Crohn/cirugía , Corticoesteroides/uso terapéutico , Esteroides/uso terapéutico , Productos Biológicos/uso terapéutico
19.
Dis Colon Rectum ; 67(S1): S1-S10, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38441240

RESUMEN

BACKGROUND: An ileoanal pouch with IPAA is the preferred method to restore intestinal continuity in patients who require a total proctocolectomy. Pouch surgery has evolved during the past decades thanks to increased experience and research, changes in the medical management of patients who require an ileal pouch, and technological innovations. OBJECTIVE: To review the main changes in pouch surgery over the past 2 decades, with a focus on staging, minimally invasive and transanal approaches, pouch design, and anastomotic configuration. RESULTS: The decision on the staging approach depends on the patient's conditions, their indication for surgery, and the risk of anastomotic leak. A minimally invasive approach should be performed whenever feasible, but open surgery still has a role in this technically demanding operation. Transanal IPAA may be performed in experienced centers and may reduce conversion to open surgery in the hostile pelvis. The J-pouch is the easiest, fastest, and most commonly performed design, but other designs may be used when a J-pouch is not feasible. A stapled anastomosis without mucosectomy can be safely performed in the majority of cases, with a low incidence of rectal cuff neoplasia and better functional outcomes than handsewn. Finally, Crohn's disease is not an absolute contraindication to an ileoanal pouch, but pouch failure may be higher compared to other indications. CONCLUSIONS: Many technical nuances contribute to the success of an ileoanal pouch. The current standard of care is a laparoscopic J-pouch with double-stapled anastomosis, but this should not be seen as a dogma, and the optimal approach and design should be tailored to each patient. See video from symposium.


Asunto(s)
Reservorios Cólicos , Proctocolectomía Restauradora , Humanos , Proctocolectomía Restauradora/métodos , Proctocolectomía Restauradora/efectos adversos , Reservorios Cólicos/efectos adversos , Laparoscopía/métodos , Colitis Ulcerosa/cirugía , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/efectos adversos , Enfermedad de Crohn/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos
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