Techniques in Coloproctology最新文献

{"title":"The outcomes of robotic ileocolic resection in Crohn's disease compared with laparoscopic and open surgery: a meta-analysis and systematic review.","authors":"M Flaifel, S Eichenberg, B Mohandes, E Taha, L Kollmann, S Flemming, A Haberstroh, N Ortlieb, N Melling, K Neumann, S Taha-Mehlitz, T Poškus, D M Frey, P C Cattin, A Taha, J Zeindler, R Rosenberg, B Saad, M D Honaker","doi":"10.1007/s10151-025-03116-4","DOIUrl":"10.1007/s10151-025-03116-4","url":null,"abstract":"<p><strong>Background: </strong>This is the first review providing insights into the outcomes of robotic ileocolic resection for Crohn's disease, potentially guiding improved surgical decisions and patient outcomes and comparing outcomes with laparoscopic and open approaches.</p><p><strong>Methods: </strong>The review was registered prospectively with PROSPERO (CRD42024504839). A comprehensive search of MEDLINE, Embase, Scopus, and Cochrane Central databases for studies on robotic ileocolic resection for Crohn's disease from inception to February 2024 was conducted. Eligible studies included participants over 18 years of age with Crohn's disease undergoing robotic ileocolic resection. Data were extracted according to PRISMA guidelines. For single-arm analyses, the random-effects model was used, while two-arm analyses employed the inverse variance and Mantel-Haenszel methods.</p><p><strong>Results: </strong>The analysis included eight studies with 5760 patients, among whom 369 underwent robotic ileocolic resection. The mean operative time for robotic procedures was 226 min. Postoperative complications included ileus in 12.50% and wound complications in 7.00%, while reoperations and readmissions occurred in 3.60% and 13.20% of patients, respectively. When compared with laparoscopic procedures, robotic procedures showed shorter length of hospital stay and longer operative times but similar total complication, reoperation, and conversion rates. In contrast, robotic procedures had fewer total postoperative complications compared with open surgeries, despite longer operative times.</p><p><strong>Conclusions: </strong>Robotic ileocolic resection for Crohn's disease, while having a longer operative time, results in fewer postoperative complications compared with open surgery and shows comparable outcomes to laparoscopic procedures with shorter hospital stays.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"88"},"PeriodicalIF":2.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bionic concepts for assessment of defecatory function and dysfunction.","authors":"D Sun, S Bao, H Yao, Y Hu, Z Huang, P Ran, L Bao, H Gregersen","doi":"10.1007/s10151-025-03125-3","DOIUrl":"10.1007/s10151-025-03125-3","url":null,"abstract":"<p><p>Bionic technology is gaining momentum in medical research. In gastroenterology, bionic technologies such as the PillCam and SmartPill assess intestinal mucosa morphology and function during the gastrointestinal passage of the devices. Oral drug delivery devices and intestinal robots are other bionic technologies under development. Recently, Fecobionics, a simulated feces, was developed for assessment of anorectal (defecatory) function. It is an anally insertable device with shape and consistency like feces. The integrated device measures anorectal pressures, orientation, bending (a proxy of the anorectal angle), and the shape of the device when located in rectum and when being evacuated by patients. It integrates most elements of the current technologies on the market (balloon expulsion technology, high-resolution anorectal manometry, defecography, and the functional luminal imaging probe). Multiple measurements in a single study by a bionic device have obvious advantages since novel functional parameters can be computed. Several Fecobionics prototypes have been developed and evaluated in normal human subjects and in patients with fecal incontinence and defecatory disorders such as obstructed defecation. This paper provides an overview of the Fecobionics platform for assessment of defecatory function and dysfunction with a focus on design, signal processing, data analysis, current clinical trials, and future applications in diagnostics, therapy assessment, and therapy.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"86"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is a bridge (rod) necessary for loop ileostomy? A phase II randomized control trial.","authors":"C Sabbagh, F Mauvais, M Demouron, F Browet, L Tartar, H Hariz, V Bridoux, J-J Tuech, M Diouf, J-M Regimbeau","doi":"10.1007/s10151-025-03132-4","DOIUrl":"10.1007/s10151-025-03132-4","url":null,"abstract":"<p><strong>Background: </strong>The value of a bridge in loop ileostomies is debated. We aimed to evaluate whether using a bridge when creating a loop ileostomy can reduce morbidity following an ileostomy.</p><p><strong>Methods: </strong>Patients who had a loop ileostomy after elective colorectal surgery from January 2016 to July 2022 were randomized in this multicenter phase 2 randomized superiority trial. The primary endpoint was the absence of postoperative stomal complications at 2 months and was assessed in a blinded fashion by a stoma therapist. Secondary endpoints were morbidity at 1 month and the STOMA-QOL score at 2 months.</p><p><strong>Results: </strong>During the study period, 67 patients were randomized to the bridge group and 63 to the no-bridge group. Epidemiological and perioperative data did not differ between the two groups. The stomal complication-free rate was 76% in the bridge group and 67% in the no-bridge group (p = 0.3). There was no difference in the distribution of complications at 1 month according to the Clavien-Dindo score (p = 0.2) or the STOMA-QOL score at 2 months (p = 0.4) between the two groups.</p><p><strong>Conclusion: </strong>The bridge does not reduce the rate of stomatal complications, nor does it appear to reduce patients' quality of life.</p><p><strong>Trial registration number: </strong>NCT02756273 (May 10, 2016).</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"87"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of laparoscopic lateral suspension and high uterosacral ligament suspension for apical prolapse: a retrospective clinical study.","authors":"Y Yu, L Mei, Y Chen, T Cui, D Wei, X Niu","doi":"10.1007/s10151-025-03124-4","DOIUrl":"10.1007/s10151-025-03124-4","url":null,"abstract":"<p><strong>Background: </strong>The aim of this retrospective clinical study is to assess clinical outcomes and patient satisfaction between laparoscopic lateral suspension (LLS) with mesh and laparoscopic high uterosacral ligament suspension (LHUS) for apical prolapse with or without anterior prolapse.</p><p><strong>Methods: </strong>Patients who underwent LLS with mesh or LHUS from 2019 to 2023 at the Second West China Hospital of Sichuan University were enrolled in this retrospective study. The objective outcomes were evaluated on the basis of the anatomical success rate according to the Pelvic Organ Prolapse Quantification System (POP-Q). The subjective outcomes were assessed using the Pelvic Floor Distress Inventory (PFDI-20) questionnaire, Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Improvement (PGI-I) scores, and complications rate. Complications were defined according to the Clavien-Dindo scale. The outcomes of the postoperative 3, 6, and 12 months were analyzed retrospectively.</p><p><strong>Results: </strong>The objective and subjective outcomes indicated improvements in both groups. There was no statistically significant difference between the two groups in the change of subjective outcomes. The short-term objective and subjective outcomes for both techniques were found to be comparable. The anatomical success rate for apical and anterior prolapse was 93.85% in the LHUS group and 93.44% in the LLS group at a median follow-up of 12 months. LLS demonstrated a superior effect on the degree of postoperative point Ba (the distance from the most protruding point to the hymen on the anterior vaginal wall) improvement compared with LHUS.</p><p><strong>Conclusions: </strong>LHUS and LLS are both effective, safe surgical techniques for the treatment of apical prolapse, with or without concomitant anterior prolapse, exhibiting low complication rates and high short-term anatomical cure rates. LLS demonstrated certain advantages over LHUS in terms of anterior prolapse improvement and symptom relief.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"84"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A proactive technique for reversal of Hartmann's procedure: lifting the rectal stump to the abdominal wall.","authors":"A Fukada, T Ogino, Y Fujimoto, Y Sekido, M Takeda, T Hata, A Hamabe, N Miyoshi, M Uemura, T Mizushima, H Eguchi, Y Doki","doi":"10.1007/s10151-025-03128-0","DOIUrl":"10.1007/s10151-025-03128-0","url":null,"abstract":"<p><strong>Background: </strong>Reversing Hartmann's procedure is complicated owing to dense adhesions resulting from inflammation in the pelvic region. These adhesions pose challenges in identifying the rectum and increase the risk of pelvic organ injuries.</p><p><strong>Methods: </strong>We propose a technique to lift and fix the rectal stump to the abdominal wall to diminish adhesions to the rectum and facilitate identification of the rectal stump.</p><p><strong>Results: </strong>The patient underwent Hartmann's procedure for generalized peritonitis resulting from perforation of the sigmoid colon. The abdominal cavity was significantly contaminated with fecal ascites, and postoperative pelvic adhesions were anticipated. Therefore, the rectal stump was lifted. The outcomes demonstrated that despite the presence of dense adhesions in the abdominal cavity, the rectal segment was promptly identified during the reversal of Hartmann's procedure. The procedure proceeded smoothly and was deemed satisfactory.</p><p><strong>Conclusions: </strong>The technique of lifting and fixing the rectal stump to the abdominal wall is useful in cases where dense pelvic adhesions are anticipated during the subsequent reversal of Hartmann's procedure.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"85"},"PeriodicalIF":2.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11933214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral antimicrobial prophylaxis was associated with preventing surgical site infection following 2-stage restorative proctocolectomy in patients with ulcerative colitis.","authors":"Y Horio, M Uchino, Y Tomoo, K Nomura, K Nagano, K Kusunoki, R Kuwahara, K Kimura, K Kataoka, N Beppu, T Ueda, K Ichiki, K Nakajima, M Ikeda, H Ikeuchi","doi":"10.1007/s10151-025-03126-2","DOIUrl":"10.1007/s10151-025-03126-2","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection (SSI) is a critical issue in colorectal surgery because it decreases postoperative patient quality of life. The rate of SSI in patients with ulcerative colitis (UC) receiving immunosuppressive therapy is particularly high, suggesting that the SSI rate may increase with the introduction of biologic agents.</p><p><strong>Methods: </strong>UC patients who underwent two-stage restorative proctocolectomy at our institution between April 2012 and December 2023 were included in this study. Clinical characteristics were analyzed and compared between an SSI group and a non-SSI group; possible risk factors for SSIs were also analyzed. Additionally, the following anti-SSI measures adopted at our hospital were included as explanatory variables: laparoscopic surgery, oral antibiotic prophylaxis and change of surgical instruments before wound closure.</p><p><strong>Results: </strong>In total, 501 UC surgical patients were included. The incidence of overall SSIs was 45/501 (8.9%). The rates of incisional SSIs and organ/space SSIs were 26/501 (5.1%) and 30/501 (5.9%), respectively. Oral antibiotic prophylaxis was identified as a risk factor for overall SSIs (odds ratio: 0.45, 95% CI 0.20-0.99, p = 0.02), incisional SSIs (odds ratio: 0.34, 95% CI 0.11-1.03, p = 0.03) and organ/space SSIs (odds ratio: 0.35, 95% CI 0.12-0.98, p = 0.04). The use of biologic and immunosuppressive agents was not associated with any SSIs.</p><p><strong>Conclusions: </strong>Nonadministration of oral antibiotic prophylaxis was identified as a risk factor for SSIs. Oral antibiotic prophylaxis before restorative proctocolectomy may improve the postoperative quality of life of UC patients by preventing SSIs.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"83"},"PeriodicalIF":2.7,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11930863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular pedicle dissection time in laparoscopic colectomies as a novel marker of surgical skill: a prospective cohort study.","authors":"Kirsten de Burlet, Isaac Tranter-Entwistle, Jeffrey Tan, Anthony Lin, Siraj Rajaratnam, Saxon Connor, Timothy Eglinton","doi":"10.1007/s10151-025-03121-7","DOIUrl":"10.1007/s10151-025-03121-7","url":null,"abstract":"<p><strong>Background: </strong>Outcomes after colorectal resections depend on patient, pathology and operative factors. Existing validated surgical skills scores (such as the competency assessment tool (CAT)) are directly correlated with outcomes but are time-consuming to administer, limiting their clinical utility. The vascular pedicle dissection time (VPDT) is a novel, simple surgical skill assessment measure with the potential for computer vision automation. This study aimed to assess the VPDT and benchmark it against the CAT score.</p><p><strong>Methods: </strong>A prospective multicentre study was performed in New Zealand, recording videos of laparoscopic colorectal resections. Patient, operation and histology characteristics were also collected. The VPDT was calculated from retraction of the vascular pedicle to completion of medial dissection, including vascular division. Each laparoscopic video was scored by two independent colorectal surgeons, and the median CAT score was grouped into tertiles.</p><p><strong>Results: </strong>In total, 154 patients were included between December 2020 and November 2023 (74 (48.1%) right-sided and 80 (51.9%) left-sided resections). Median VPDT was significantly different between the CAT score groups for the right-sided resections (lower, 15 min; middle, 13 min; higher, 10 min; p = 0.036) and the left-sided resections (lower, 46 min; middle, 40 min; higher, 26 min; p =  < 0.001). There was no significant difference in R1 resection, anastomotic leak rate, the occurrence of Clavien-Dindo > 3 complications or re-admission between the CAT groups.</p><p><strong>Conclusions: </strong>This study showed that the VPDT was inversely correlated with the CAT score, indicating that it quantifies operative technical skill. A current study is evaluating the suitability of VPDT for real-time measurement using computer vision algorithms. This could allow for automated assessment of surgeons' learning curve and skills.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"82"},"PeriodicalIF":2.7,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why did we encounter a pCRM-positive specimen whose preoperative MRI indicates negative mesorectal fascia involvement in middle to low rectal cancer?","authors":"F Sumiyama, M Hamada, T Kobayashi, Y Matsumi, R Inada, H Kurokawa, Y Uemura","doi":"10.1007/s10151-025-03117-3","DOIUrl":"10.1007/s10151-025-03117-3","url":null,"abstract":"<p><strong>Background: </strong>This study aims to examine why we encounter a pathological circumferential resection margin (pCRM)-positive specimen whose preoperative MRI indicates negative mesorectal fascia involvement in middle to low rectal cancer.</p><p><strong>Methods: </strong>Forty-four consecutive patients included in this study had c(yc)T1-3 primary rectal adenocarcinoma without mesorectal fascia involvement and underwent laparoscopic total mesorectal excision (TME) with curative intent in the Department of Gastrointestinal Surgery of Kansai Medical University Hospital from January 2014 to April 2018. We adopted three checkpoints to investigate the misleading point causing positive pCRM (≤ 1 mm). (1) c(yc)CRM diagnosis by two radiologists with more than 20 and 15 years of experience in rectal cancer MRI diagnosis. (2) The specimen was assessed using the TME score presented by Nagtegaal. (3) We compared the standard sectioning according to UK guidelines (group A; n = 26) with the specimen MRI image navigation-based section (group B; n = 18) in terms of estimation of pCRM by c(yc)CRM.</p><p><strong>Results: </strong>We achieved a \"complete\" resection specimen in all cases. A simple correlation coefficient in group B revealed a significant correlation between c(yc)CRM and pCRM (r = 0.663, p = 0.00513); this correlation was not significant in group A (r = 0.261, p = 0.19824). However, tests for differences between linear regression coefficients in groups A and B showed no significant differences (p = 0.12596). There were five cases of pCRM ≤ 1 mm: three in group A and two in group B. An anterior lesion caused pCRM ≤ 1 mm in three cases; the tumor deposits or extramural vascular invasion caused the other cases.</p><p><strong>Conclusion: </strong>The cause of misleading pCRM was the inaccurate preoperative MRI diagnosis of c(yc)CRM.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"81"},"PeriodicalIF":2.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended versus limited mesenteric excision in bowel resection for Crohn's disease: a meta-analysis and systematic review.","authors":"B F Pompeu, P Marcolin, F I L C B Marques, G A da Rocha Soares, A L C E Silva, B D'Andrea Pigossi, S M P de Figueiredo, F B Formiga","doi":"10.1007/s10151-024-03108-w","DOIUrl":"10.1007/s10151-024-03108-w","url":null,"abstract":"<p><strong>Background: </strong>There is ongoing debate regarding the benefits of extended mesenteric excision (EME) versus limited mesenteric excision (LME) in intestinal resection for Crohn's disease (CD). Some studies suggest that EME may reduce surgical recurrence, which is defined as the need for reoperation due to disease complications or insufficient response to therapy, when compared with LME. This systematic review and meta-analysis aims to compare postoperative complications, surgical recurrence, and endoscopic recurrence in patients undergoing EME versus LME for CD.</p><p><strong>Methods: </strong>MEDLINE, Cochrane, the Central Register of Clinical Trials, Scopus and Web of Science databases were searched for studies published through April 2024. Odds ratios (OR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed with Cochran's Q test and I² statistics, with p-values < 0.10 and I² > 25% considered significant. Statistical analyses were performed using R software, version 4.4.1.</p><p><strong>Results: </strong>One randomized controlled trial (RCT) and five observational studies were included, totaling 4498 patients, of whom 1059 (23.5%) underwent EME and 3439 (76.5%) LME. EME was associated with a lower surgical recurrence rate (5% versus 15%; OR 0.31; 95% CI 0.12-0.84; p = 0.021; I² = 47%). No significant differences were observed between EME and LME for overall complications, Clavien-Dindo ≥ 3 events, bleeding requiring transfusion, anastomotic leaks, intraabdominal abscesses, surgical site infections (SSIs), reoperations, readmissions, ileus, endoscopic recurrences, operative times, or hospital stays.</p><p><strong>Conclusions: </strong>EME was associated with a significant reduction in surgical recurrence compared with LME, without differences in endoscopic recurrence or postoperative complication rates.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"80"},"PeriodicalIF":2.7,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To cut or not to cut? Extended mesenteric excision during intestinal resection does not impact the postoperative recurrence nor the postoperative complications in Crohn's disease: a systematic review and meta-analysis.","authors":"M Topala, P Martinekova, A Rancz, D S Veres, K Lenti, P Miheller, B Erőss, P Hegyi, S Ábrahám","doi":"10.1007/s10151-025-03110-w","DOIUrl":"10.1007/s10151-025-03110-w","url":null,"abstract":"<p><strong>Background: </strong>The mesentery might be involved in the pathogenesis of Crohn's disease (CD). As a result of scarce and conflicting data, it is debatable whether removal during intestinal resections could influence postsurgical outcome. We aimed to investigate the association between the extent of mesenteric excision during intestinal resections and postoperative complications and recurrence.</p><p><strong>Methods: </strong>We conducted a systematic search in five databases on 29 July 2024 for studies reporting outcomes in patients with CD who underwent intestinal resections with extended mesenteric excision (EME) compared with limited mesenteric excision (LME). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using the random-effects model. We assessed the risk of bias using the ROBINS-I and RoB2 tool and evaluated the certainty of evidence according to the GRADE Working Group recommendations.</p><p><strong>Results: </strong>We retrieved data from six studies, covering 4590 patients. The pooled data showed no significant difference between EME and LME patients regarding surgical recurrence (OR 0.3; 95% CI 0.02-3.73; p = 0.176), overall postoperative complications (OR 0.78; 95% CI 0.33-1.82, p = 0.329), anastomotic leak (OR 0.76, 95% CI 0.09-6.85, p = 0.722), surgical site infection (OR 0.84, 95% CI 0.3-2.36, p = 0.539), reoperation rate (OR 1.09, 95% CI 0.33-3.58, p = 0.783), or hospitalization (MD - 0.33 (95% CI - 1.8 to 1.15, p = 0.53). Individual studies reported similar results regarding 6 months follow-up endoscopic recurrence. The certainty of evidence was very low and low, respectively.</p><p><strong>Conclusion: </strong>Extended mesenteric excision is not statistically associated with improved postoperative complications or postoperative recurrence. Results should be interpreted cautiously because of the small number of studies; hence, randomized, long-term, controlled trials are needed.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"79"},"PeriodicalIF":2.7,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11890256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}