{"title":"重做回结肠切除术治疗克罗恩病,能像初次切除术一样减轻患者病情吗?","authors":"David Hazzan, Gali Westrich, Lior Segev","doi":"10.1089/lap.2024.0146","DOIUrl":null,"url":null,"abstract":"<p><p><b><i>Objective:</i></b> We questioned how redo ileocolic resection (R-ICR) in Crohn's disease (CD) alleviates patients in the long-term compared with primary resection. <b><i>Methods:</i></b> A single-center retrospective analysis of patients who underwent an elective ICR without diversion between the years 2010-2022. The cohort was divided into two groups, namely, R-ICR and primary ileocolic resection (P-ICR). <b><i>Results:</i></b> The study included 181 patients, of which 30 patients are in the R-ICR group (mean age 42.3 years) and 151 patients in the P-ICR group (mean age 32.6 years). The R-ICR patients underwent an open approach (76.7% versus 25.2% among the P-ICR, <i>p</i> < .001), had significantly longer operations (mean 200.9 minutes versus 157.2 minutes, respectively, <i>P</i> = .002), and had higher estimated blood loss (mean 350 mL versus 267.4 mL, <i>P</i> = .043). The groups were similar in overall postoperative morbidity, severe postoperative complications (10% versus 13.2%, <i>P</i> = .762), and median length of hospital stay (12.1 days versus 7.4 days, <i>P</i> = .214). After a median follow-up of 64.2 months, there were no significant differences between the groups in terms of endoscopic recurrence (43.3% versus 60.9% in the P-ICR group, <i>P</i> = .104) or in clinical recurrence (43.3% versus 55.6%, respectively, <i>P</i> = .216), but the R-ICR had a significant higher rate of surgical recurrences (23.3% versus 5.3%, respectively, <i>P</i> = .004). <b><i>Conclusion:</i></b> R-ICR for CD is a significantly more challenging operation than the primary resection, and patients undergoing a R-ICR are more susceptible to a future surgical intervention than those having P-ICR.</p>","PeriodicalId":50166,"journal":{"name":"Journal of Laparoendoscopic & Advanced Surgical Techniques","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Redo Ileocolic Resection for Crohn's Disease, Does It Palliate the Patients as Good as the Primary Resection?\",\"authors\":\"David Hazzan, Gali Westrich, Lior Segev\",\"doi\":\"10.1089/lap.2024.0146\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b><i>Objective:</i></b> We questioned how redo ileocolic resection (R-ICR) in Crohn's disease (CD) alleviates patients in the long-term compared with primary resection. <b><i>Methods:</i></b> A single-center retrospective analysis of patients who underwent an elective ICR without diversion between the years 2010-2022. The cohort was divided into two groups, namely, R-ICR and primary ileocolic resection (P-ICR). <b><i>Results:</i></b> The study included 181 patients, of which 30 patients are in the R-ICR group (mean age 42.3 years) and 151 patients in the P-ICR group (mean age 32.6 years). The R-ICR patients underwent an open approach (76.7% versus 25.2% among the P-ICR, <i>p</i> < .001), had significantly longer operations (mean 200.9 minutes versus 157.2 minutes, respectively, <i>P</i> = .002), and had higher estimated blood loss (mean 350 mL versus 267.4 mL, <i>P</i> = .043). The groups were similar in overall postoperative morbidity, severe postoperative complications (10% versus 13.2%, <i>P</i> = .762), and median length of hospital stay (12.1 days versus 7.4 days, <i>P</i> = .214). After a median follow-up of 64.2 months, there were no significant differences between the groups in terms of endoscopic recurrence (43.3% versus 60.9% in the P-ICR group, <i>P</i> = .104) or in clinical recurrence (43.3% versus 55.6%, respectively, <i>P</i> = .216), but the R-ICR had a significant higher rate of surgical recurrences (23.3% versus 5.3%, respectively, <i>P</i> = .004). <b><i>Conclusion:</i></b> R-ICR for CD is a significantly more challenging operation than the primary resection, and patients undergoing a R-ICR are more susceptible to a future surgical intervention than those having P-ICR.</p>\",\"PeriodicalId\":50166,\"journal\":{\"name\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.1000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Laparoendoscopic & Advanced Surgical Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1089/lap.2024.0146\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/15 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Laparoendoscopic & Advanced Surgical Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1089/lap.2024.0146","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/15 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
Redo Ileocolic Resection for Crohn's Disease, Does It Palliate the Patients as Good as the Primary Resection?
Objective: We questioned how redo ileocolic resection (R-ICR) in Crohn's disease (CD) alleviates patients in the long-term compared with primary resection. Methods: A single-center retrospective analysis of patients who underwent an elective ICR without diversion between the years 2010-2022. The cohort was divided into two groups, namely, R-ICR and primary ileocolic resection (P-ICR). Results: The study included 181 patients, of which 30 patients are in the R-ICR group (mean age 42.3 years) and 151 patients in the P-ICR group (mean age 32.6 years). The R-ICR patients underwent an open approach (76.7% versus 25.2% among the P-ICR, p < .001), had significantly longer operations (mean 200.9 minutes versus 157.2 minutes, respectively, P = .002), and had higher estimated blood loss (mean 350 mL versus 267.4 mL, P = .043). The groups were similar in overall postoperative morbidity, severe postoperative complications (10% versus 13.2%, P = .762), and median length of hospital stay (12.1 days versus 7.4 days, P = .214). After a median follow-up of 64.2 months, there were no significant differences between the groups in terms of endoscopic recurrence (43.3% versus 60.9% in the P-ICR group, P = .104) or in clinical recurrence (43.3% versus 55.6%, respectively, P = .216), but the R-ICR had a significant higher rate of surgical recurrences (23.3% versus 5.3%, respectively, P = .004). Conclusion: R-ICR for CD is a significantly more challenging operation than the primary resection, and patients undergoing a R-ICR are more susceptible to a future surgical intervention than those having P-ICR.
期刊介绍:
Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.