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Redo ileocolic resection for recurrent Crohn’s disease: A review and meta-analysis of surgical outcomes

Published:October 18, 2022DOI:https://doi.org/10.1016/j.surg.2022.09.003

      Abstract

      Background

      Recurrence of postoperative Crohn’s disease neccesitating repeat ileocolic resection is a common problem. The aim of this meta-analysis was to present the collective evidence on the surgical outcomes of this procedure.

      Methods

      PubMed, Scopus, and Google Scholar were searched for eligible studies that reported the surgical outcomes of redo ileocolic resection for Crohn’s disease. The primary outcomes were overall and major complication rates. The secondary outcome was anastomotic leak and conversion rate. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies – of Interventions tool.

      Results

      This meta-analysis included 12 studies comprising 1,203 patients (50% men). The weighted mean rate of overall complications was 31.8% (95% confidence interval, 25–38.6) and rate of major complications was 8% (95% confidence interval, 5.7–10.2). The weighted mean rate of conversion was 20.9%, and the weighted mean rate of anastomotic leak was 3% (95% confidence interval, 1.8%–4.3%; inconsistency = 0). Male sex (slope coefficient = 0.0001; P = .01), American Society of Anesthesiologists score >3 (slope coefficient = 0.001; P = .04), smoking (slope coefficient = 0.0001; P = .008), preoperative use of steroid therapy (slope coefficient = 0.0001; P = .009), open approach (slope coefficient = 0.0001; P = .005), and having ≥2 previous resections (slope coefficient = 0.0001; P = .02) were significant risk factors for major complications.

      Conclusion

      Although redo ileocolic resection for patients with recurrent Crohn disease has a relatively high overall complication rate, a majority of these complications are minor and anastomotic leak rate is relatively low. Further prospective multicenter trials are warranted to confirm the conclusions of this meta-analysis.
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      References

        • Crohn B.B.
        • Ginzburg L.
        • Oppenheimer G.D.
        Regional ileitis: a pathologic and clinical entity.
        J Am Med Assoc. 1932; 99: 1323-1329
        • Bernell O.
        • Lapidus A.
        • Hellers G.
        Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease.
        Br J Surg. 2000; 87: 1697-1701
        • Lim J.Y.
        • Kim J.
        • Nguyen S.Q.
        Laparoscopic surgery in the management of Crohn’s disease.
        World J Gastrointest Pathophysiol. 2014; 5: 200
        • Buisson A.
        • Chevaux J.B.
        • Allen P.B.
        • et al.
        Review article: the natural history of postoperative Crohn’s disease recurrence.
        Aliment Pharmacol Ther. 2012; 35: 625-633
        • de Buck van Overstraeten A.
        • Eshuis E.J.
        • Vermeire S.
        • et al.
        Short- and medium-term outcomes following primary ileocaecal resection for Crohn’s disease in two specialist centres.
        Br J Surg. 2017; 104: 1713-1722
        • Huang R.
        • Valerian B.T.
        • Lee E.C.
        Laparoscopic approach in patients with recurrent Crohn’s disease.
        Am Surg. 2012; 78: 595-599
        • Heimann T.M.
        • Greenstein A.J.
        • Lewis B.
        • et al.
        Comparison of primary and reoperative surgery in patients with Crohns disease.
        Ann Surg. 1998; 227: 492-495
        • Carmichael H.
        • Peyser D.
        • Baratta V.M.
        • et al.
        The role of laparoscopic surgery in repeat ileocolic resection for Crohn’s disease.
        Colorectal Dis. 2021; 23: 2075-2084
        • Colombo F.
        • Frontali A.
        • Baldi C.
        • et al.
        Repeated surgery for recurrent Crohn’s disease: does the outcome keep worsening operation after operation? A comparative study of 1224 consecutive procedures.
        Updates Surg. 2022; 74: 73-80
        • Freund M.R.
        • Kent I.
        • Horesh N.
        • et al.
        Redo ileocolic resection in Crohn’s disease - does time passed since previous surgery matter?.
        Colorectal Dis. 2022; 24: 484-490
        • Freund M.R.
        • Kent I.
        • Agarwal S.
        • Wexner S.D.
        Use of indocyanine green fluorescence guidance in redo ileocolic resection for Crohn’s disease.
        Colorectal Dis. 2021; 23: 3190-3195
        • Celentano V.
        Laparoscopic redo surgery in recurrent ileocolic Crohn’s disease: a standardised technique.
        J Minim Access Surg. 2020; 16: 90-93
        • Page M.J.
        • McKenzie J.E.
        • Bossuyt P.M.
        • et al.
        The PRISMA 2020 statement: an updated guideline for reporting systematic reviews.
        BMJ. 2021; 372: n71
        • Clavien P.A.
        • Barkun J.
        • de Oliveira M.L.
        • et al.
        The Clavien-Dindo classification of surgical complications: five-year experience.
        Ann Surg. 2009; 250: 187-196
        • Holubar S.D.
        • Dozois E.J.
        • Privitera A.
        • et al.
        Laparoscopic surgery for recurrent ileocolic Crohn’s disease.
        Inflamm Bowel Dis. 2010; 16: 1382-1386
        • Brouquet A.
        • Bretagnol F.
        • Soprani A.
        • et al.
        A laparoscopic approach to iterative ileocolonic resection for the recurrence of Crohn’s disease.
        Surg Endosc. 2010; 24: 879-887
        • Wu J.S.
        • Birnbaum E.H.
        • Kodner I.J.
        • et al.
        Laparoscopic-assisted ileocolic resections in patients with Crohn’s disease: are abscesses, phlegmons, or recurrent disease contraindications?.
        Surgery. 1997; 122: 682-689
        • Hasegawa H.
        • Watanabe M.
        • Nishibori H.
        • et al.
        Laparoscopic surgery for recurrent Crohn’s disease.
        Br J Surg. 2003; 90: 970-973
        • Pinto R.A.
        • Shawki S.
        • Narita K.
        • et al.
        Laparoscopy for recurrent Crohn’s disease: how do the results compare with the results for primary Crohn’s disease?.
        Colorectal Dis. 2011; 13: 302-307
        • Chaudhary B.
        • Glancy D.
        • Dixon A.R.
        Laparoscopic surgery for recurrent ileocolic Crohn’s disease is as safe and effective as primary resection.
        Colorectal Dis. 2011; 13: 1413-1416
        • Abdalla S.
        • Brouquet A.
        • Maggiori L.
        • et al.
        postoperative morbidity after iterative ileocolonic resection for Crohn’s disease: should we be worried? A prospective multicentric cohort study of the GETAID Chirurgie.
        J Crohns Colitis. 2019; 13: 1510-1517
        • Bouquot M.
        • Maggiori L.
        • Hain E.
        • et al.
        What is the outcome for patients undergoing more than two ileocolonic resections for recurrent Crohn’s disease? A comparative study of 569 consecutive procedures.
        Colorectal Dis. 2019; 21: 563-569
        • Celentano V.
        • Sagias F.
        • Flashman K.G.
        • et al.
        Laparoscopic redo ileocolic resection for crohn’s disease in patients with previous multiple laparotomies.
        Scand J Surg. 2019; 108: 42-48
        • Shigeta K.
        • Okabayashi K.
        • Hasegawa H.
        • et al.
        Meta-analysis of laparoscopic surgery for recurrent Crohn’s disease.
        Surg Today. 2016; 46: 970-978
        • Colombel J.F.
        • Loftus E.v.
        • Tremaine W.J.
        • et al.
        Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy.
        Am J Gastroenterol. 2004; 99: 878-883
        • Kalman T.D.
        • Everhov H.
        • Nordenvall C.
        • et al.
        Decrease in primary but not in secondary abdominal surgery for Crohn’s disease: nationwide cohort study, 1990-2014.
        Br J Surg. 2020; 107: 1529-1538
        • Feuerstein J.D.
        • Ho E.Y.
        • Shmidt E.
        • et al.
        AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn’s disease.
        Gastroenterology. 2021; 160: 2496-2508
        • Lightner A.L.
        • Vogel J.D.
        • Carmichael J.C.
        • et al.
        The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of Crohn’s disease.
        Dis Colon Rectum. 2020; 63: 1028-1052
        • Neary P.M.
        • Aiello A.C.
        • Stocchi L.
        • et al.
        High-risk ileocolic anastomoses for Crohn’s disease: when is diversion indicated?.
        J Crohn’s Colitis. 2019; 13: 856-863
        • Michelassi F.
        • Balestracci T.
        • Chappell R.
        • Block G.E.
        Primary and recurrent Crohn’s disease. Experience with 1379 patients.
        Ann Surg. 1991; 214: 230-240
        • Moorthy K.
        • Shaul T.
        • Foley R.J.
        Factors that predict conversion in patients undergoing laparoscopic surgery for Crohn’s disease.
        Am J Surg. 2004; 187: 47-51
        • Rosman A.S.
        • Melis M.
        • Fichera A.
        Metaanalysis of trials comparing laparoscopic and open surgery for Crohn’s disease.
        Surg Endosc. 2005; 19: 1549-1555
        • Tilney H.S.
        • Constantinides V.A.
        • Heriot A.G.
        • et al.
        Comparison of laparoscopic and open ileocecal resection for Crohn’s disease: a metaanalysis.
        Surg Endosc. 2006; 20: 1036-1044
        • Polle S.W.
        • Wind J.
        • Ubbink D.T.
        • et al.
        Short-term outcomes after laparoscopic ileocolic resection for Crohn’s disease. A systematic review.
        Dig Surg. 2006; 23: 346-357
        • Milsom J.W.
        • Hammerhofer K.A.
        • Böhm B.
        • et al.
        Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refractory ileocolic Crohn’s disease.
        Dis Colon Rectum. 2001; 44: 1-9
        • Lee Y.
        • Fleming F.J.
        • Deeb A.P.
        • et al.
        A laparoscopic approach reduces short-term complications and length of stay following ileocolic resection in Crohn’s disease: an analysis of outcomes from the NSQIP database.
        Colorectal Dis. 2012; 14: 572-577
        • Satsangi J.
        • Silverberg M.S.
        • Vermeire S.
        • Colombel J.F.
        The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications.
        Gut. 2006; 55: 749-753