Wide mesenterectomy is associated with reduced postoperative recurrence following surgery for Crohn’s disease
LG Walsh, MG Kiernan, H Hedayat, SM Sahebally, A Jarrar, JP Burke, J Hogan, PA Kiely, B Shen, M Moloney, M Skelly, D Leddin, PN Faul, V Healy, PR O’ Connell, S Martin, F Shanahan, C Dunne, D Waldron, E Condon, JC Coffey
Department of Surgery, University Hospital Limerick, Graduate Entry Medical School, University of Limerick, 4i Centre for interventions in Infection, Inflammation and Immunity, The Lerner College of Medicine, the Cleveland Clinic Foundations, Cleveland, Ohio, USA, Department of Colorectal Surgery, the Cleveland Clinic Foundation, Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, School of Medicine and Medical Sciences, UCD, Department of Life Sciences, Materials and Surface Science Institute and Stokes Institute, University of Limerick, Department of Gastroenterology/Hepatology, the Cleveland Clinic Foundation, Department of Gastroenterology, University Hospital Limerick.
Conservative approaches are conventionally adopted in the surgical management of Crohn’s disease (CD). Recent advancements in mesenteric anatomy now enable a more radical approach to mesenteric resection. We report outcomes when a more radical “wide” mesenteric resection is conducted for Crohn’s disease.
To identify differences in early surgical recurrence rates between patients undergoing close mesenterectomy in comparison to those undergoing wide mesenterectomy.
Two cohorts were compared, i.e. “close” and “wide” mesenterectomy. The former, an historic cohort, comprised of patients undergoing conventional surgery for CD. As such, the mesentery was divided and resected close to the gastrointestinal margin. Data were collected retrospectively and collated into a database. The latter cohort consisted of 38 patients collated prospectively who underwent wide or radical mesenterectomy at time of gastrointestinal resection. Both cohorts were compared for the rate of surgical recurrence within three years of patients’ index resections.
Surgical recurrence rates (i.e. symptoms necessitating repeat resection) were 27% and 2.7% in close and wide mesenterectomy cohorts respectively (p=0.077). In the wide mesenterectomy group, only one patient has required repeat surgery for symptoms of CD. Wide mesenterectomy was not feasible in four patients. These individuals underwent defunctioning ileostomy following by a staged resection after four to eight months. With exception of patients undergoing either pouchectomy or panproctocolectomy, all patients in the wide mesenterectomy cohort are currently stoma-free. Post-operative complications occurred in 5.4% of patients.
Radical or wide mesenterectomy is feasible in the surgical management of Crohn’s disease. Short term surgical recurrence rates appear reduced following a wide mesenterectomy.