“Mesentery-based surgery” to prevent surgical recurrence in Crohn’s disease: from basics to surgical practice
Surgery in Crohn’s Disease (CD) has always been based on the principle of limiting intestinal resection to the diseased tract as much as possible, thus saving precious centimeter of intestine for the patient. Traditionally, intestinal resection takes place by following the edge of digestive tube, keeping away from the vessels that go into the mesentery and the mesocolon, unlike cancer surgery which obliges the surgeon to respect the oncological principles.
Recent studies have recognized the mesentery as a single anatomical and structural unit with functional properties that plays a role in both physiological and pathological mechanisms . In particular, JC Coffey highlights that the main morphological changes of the mesentery (those detected intraoperatively by the surgeon): fat wrapping (or creeping fat) and mesenteric thickening are correlated with mucosal ulceration and degree of disease severity and that the mucosal ulceration is always confined to the mesenteric...
- 3.Kono T, Ashida T, Ebisawa Y, Chisato N, Okamoto K, Katsuno H, Maeda K, Fujiya M, Kohgo Y, Furukawa H (2011) A new antimesenteric functional end-to-end handsewn anastomosis: surgical prevention of anastomotic recurrence in Crohn’s disease. Dis Colon rectum 54(5):586–592. https://doi.org/10.1007/DCR.0b013e318208b90f CrossRefGoogle Scholar
- 4.Kono T, Fichera A, Maeda K, Sakai Y, Ohge H, Krane M, Katsuno H, Fujiya M (2016) Kono-S anastomosis for surgical prophylaxis of anastomotic recurrence in Crohn’s disease: an international multicenter study. J Gastrointest Surg 20(4):783–790. https://doi.org/10.1007/s11605-015-3061-3 CrossRefGoogle Scholar
- 5.Shimada N, Ohge H, Kono T et al., Surgical recurrence at anastomotic site after bowel resection in Crohn ’ s disease : comparison of Kono-S and end-to-end anastomosis, 2018. https://doi.org/10.1007/s11605-018-4012-6
- 8.Coffey CJ, Kiernan MG, Sahebally SM et al (2018) Inclusion of the mesentery in ileocolic resection for Crohn’s disease is associated with reduced surgical recurrence. J Crohn’s Colitis:1–12. https://doi.org/10.1093/ecco-jcc/jjx187
- 9.de Groof EJ, van der Meer JHM, Tanis PJ et al. Persistent mesorectal inflammatory activity is associated with complications after proctectomy in Crohn’s disease, J. Crohn’s Colitis, 2018. https://doi.org/10.1093/ecco-jcc/jjy131