Extended Resection of Mesentery in Crohns Disease (Review)

Abstract

INTRODUCTION: Crohns disease (CD) is a chronic inflammatory bowel disease characterized by intermittent lesions of the gut wall and transmural inflammation. The disease affects the gastrointestinal tract along the whole length from the mouth to the anus. More than 50% of patients with CD within the first 10 years following established diagnosis develop strictures or fistulas. These complications lead to intestinal obstruction which is a common indication for surgery in the volume of resection of the affected bowel. Surgery for CD complications does not rid the patient of the disease. Endoscopic and clinical recurrence of CD is a common phenomenon after surgical resection of the gut. The surgical approach to treatment of CD have not gained a wide spread since the first description of the disease. It is evident that to reduce the frequency of recurrences, it is necessary to improve surgical tactics. Clarification and better understanding of the anatomy and function of mesentery in recent years has led to the suggestion of its probable role in the pathogenesis of CD. Extended mesenteric resection may improve the outcomes of surgery in CD. Rather than to mobilize and excise the mesentery as in colorectal cancer, the mesentery is usually transected at the level of the intestine and remains in an organism. This review provides the data of recent studies of the role of mesentery in the pathogenesis of CD, which permit to suggest that extended resection of mesentery can significantly improve surgical results in CD and to reduce the frequency of endoscopic and clinical recurrences and reoperations. CONCLUSION: Mesentery is involved in the pathogenesis of Crohns disease and the development of relapse. Further study of its role will lead to a decrease in the frequency of relapses and repeated surgical interventions in Crohns disease.