Skip to main content

Advertisement

SpringerLink
Log in

Video-laparoscopic assessment of the small bowel in Crohn’s disease: a comparative study to evaluate surgeons’ inter-observer variability

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Assessment of the entire small bowel is advocated during Crohn’s disease (CD) surgery, as intraoperative detection of new lesions may lead to change in the planned procedure. The aim of this study was to evaluate the inter-observer variability in the assessment of extent and severity of CD at the small bowel laparoscopic “walkthrough”.

Methods

A survey on laparoscopic assessment of the small bowel in patients with CD, including items adapted from the MREnterography or ultrasound in Crohn's disease (METRIC) study and from the classification of severity of mesenteric disease was developed by an invited committee of colorectal surgeons. Anonymous laparoscopic videos demonstrating the small bowel “walkthrough” in ileocolonic resection for primary and recurrent CD were distributed to the committee members together with the anonymous survey. The primary outcome was the rate of inter-observer variability on assessment of strictures, dilatations, complications and severity of mesenteric inflammation.

Results

12 assessors completed the survey on 8 small bowel walkthrough videos. The evaluation of the small bowel thickening and of the mesenteric fat wrapping were the most reliable assessments with an overall agreement of 87.1% (k = 0.31; 95% CI − 0.22, 0.84) and 82.7% (k = 0.35; 95% CI − 0.04, 0.73), respectively. The presence of strictures and pre-stenotic dilatation demonstrated agreement of 75.2% (k = 0.06: 95% CI − 0.33, 0.45) and 71.2% (k = 0.33; 95% CI 0.15, 0.51), respectively. Evaluation of fistulae had an overall agreement of 75.3%, while there was a significant variation in the evaluation of mild, moderate and severe mesenteric disease with overall agreement ranging from 33.3 to 100%.

Conclusion

Laparoscopic assessment of the small bowel thickening and of the presence of mesenteric fat wrapping is reliable for the intraoperative evaluation of CD with high inter-rater agreement. There is significant heterogeneity in the assessment of the severity of the mesenteric disease involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Frolkis AD, Dykeman J, Negrón ME, Debruyn J, Jette N, Fiesta KM, Frolkis T, Barkema HW, Rioux KP, Panaccione R, Ghosh S, Wiebe S, Kaplan GG (2013) Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 145(5):996–1006

    Article  PubMed  Google Scholar 

  2. Jones DW, Finlayson SR (2010) Trends in surgery for Crohn's disease in the era of infliximab. Ann Surg 252(2):307–312

    Article  PubMed  Google Scholar 

  3. Louis E, Dotan I, Ghosh S, Mlynarsky L, Reenaers C, Schreiber S (2015) Optimising the inflammatory bowel disease unit to improve quality of care: expert recommendations. J Crohn's Colitis 9(8):685–691

    Article  Google Scholar 

  4. Morar PS, Hollingshead J, Bemelman W et al (2017) Establishing key performance indicators [KPIs] and their importance for the surgical management of inflammatory bowel disease results from a pan-European Delphi Consensus Study. J Crohn's Colitis 11(11):1362–1368

    Article  Google Scholar 

  5. Nguyen GC, Steinhart AH (2014) The impact of surgeon volume on postoperative outcomes after surgery for Crohn's disease. Inflamm Bowel Dis 20(2):301–306

    Article  PubMed  Google Scholar 

  6. Kaplan GG, McCarthy EP, Ayanian JZ, Korzenik J, Hodin R, Sands BE (2008) Impact of hospital volume on postoperative morbidity and mortality following a colectomy for ulcerative colitis. Gastroenterology 134(3):680–687

    Article  PubMed  Google Scholar 

  7. Spinelli A, Fiorino G, Bazzi P, Sacchi M, Bonifacio C, De Bastiani S, Malesci A, Balzarini L, Peyrin-Biroulet L, Montorsi M, Danese S (2014) Preoperative magnetic resonance enterography in predicting findings and optimizing surgical approach in Crohn's disease. J Gastrointest Surg 18(1):83–91

    Article  PubMed  Google Scholar 

  8. Celentano V (2018) Laparoscopic redo surgery in recurrent ileocolic Crohn's disease: a standardised technique. J Minim Access Surg 16(1):90

    Article  Google Scholar 

  9. Pellino G, Selvaggi F, Ghezzi G, Corona D, Riegler G, Delaini GG (2015) A think tank of the Italian society of colorectal surgery (SICCR) on the surgical treatment of inflammatory bowel disease using the Delphi method: Crohn's disease. Tech Coloproctol 19(10):639–651

    Article  CAS  PubMed  Google Scholar 

  10. Celentano V, Smart N, Cahill R et al (2018) LAP-VEGaS practice guidelines for reporting of educational videos in laparoscopic surgery: a joint trainers and trainees consensus statement. Ann Surg 268(6):920–926

    Article  PubMed  Google Scholar 

  11. Coleman M, Rockall T (2013) Teaching of laparoscopic surgery colorectal. The Lapco model. Cirugia espanola 91(5):279

    Article  PubMed  Google Scholar 

  12. Celentano V, Browning M, Hitchins C et al (2017) Training value of laparoscopic colorectal videos on the World Wide Web: a pilot study on the educational quality of laparoscopic right hemicolectomy videos. Surg Endosc 31(11):4496–4504

    Article  CAS  PubMed  Google Scholar 

  13. Taylor A, Mallett S et al (2018) Diagnostic accuracy of magnetic resonance enterography and small bowel ultrasound for the extent and activity of newly diagnosed and relapsed Crohn’s disease (METRIC): a multicentre trial. Lancet Gastroenterol Hepatol 3(8):548–558

    Article  PubMed  PubMed Central  Google Scholar 

  14. Coffey JC, 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 12(10):1139–1150

    Article  Google Scholar 

  15. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 147(8):W16

    Google Scholar 

  16. Marston L (2010) Introductory statistics for health and nursing using SPSS. Sage, Thousand Oaks

    Book  Google Scholar 

  17. Lesperance K, Martin MJ, Lehmann R et al (2009) National trends and outcomes for the surgical therapy of ileocolonic Crohn's disease: a population-based analysis of laparoscopic vs. open approaches. J Gastrointest Surg 13(7):1251

    Article  PubMed  Google Scholar 

  18. Marcello WP (2006) Laparoscopy for inflammatory bowel disease: pushing the envelope. Clin Colon Rect Surg 19(1):26–32

    Article  Google Scholar 

  19. Duepree HJ, Senagore AJ, Delaney CP et al (2002) Advantages of laparoscopic resection for ileocecal Crohn’s disease. Dis Colon Rectum 45(5):605–610

    Article  PubMed  Google Scholar 

  20. Booya F, Akram S, Fletcher JG et al (2009) CT enterography and fistulizing Crohn’s disease: clinical benefit and radiographic findings. Abdom Imaging 34:467

    Article  PubMed  Google Scholar 

  21. Fallis SA, Murphy P, Sinha R et al (2013) Magnetic resonance enterography in Crohn’s disease: a comparison with the findings at surgery. Colorectal Dis 15(10):1273

    Article  CAS  PubMed  Google Scholar 

  22. Higgins PD, Caoili E, Zimmermann M et al (2007) Computed tomographic enterography adds information to clinical management in small bowel Crohn’s disease. Inflamm Bowel Dis 13(3):262–268

    Article  PubMed  Google Scholar 

  23. Malagò R, Manfredi R, Benini L, D’Alpaos G, Mucelli RP (2008) Assessment of Crohn’s disease activity in the small bowel with MR-enteroclysis: clinico-radiological correlations. Abdom Imaging 33:669–675

    Article  PubMed  Google Scholar 

  24. Zappa M, Stefanescu C, Cazals-Hatem D et al (2011) Which magnetic resonance imaging findings accurately evaluate inflammation in small bowel Crohn’s disease? A retrospective comparison with surgical pathologic analysis. Inflamm Bowel Dis 17(4):984

    Article  PubMed  Google Scholar 

  25. Zielińska A, Siwiński P, Sobolewska-Włodarczyk A, Wiśniewska-Jarosińska M, Fichna J, Włodarczyk M (2019) The role of adipose tissue in the pathogenesis of Crohn’s disease. Pharmacol Rep 71(1):105–111

    Article  PubMed  Google Scholar 

  26. Sapci I, Gorgun E (2019) Minimally invasive surgery in complex Crohn's disease. Clin Colon Rectal Surg 32:300–304

    Article  PubMed  PubMed Central  Google Scholar 

  27. Pellino G, Moggia E, Novelli E, Sturiale A, Martellucci J, Trompetto M, Gallo G, Italian Society of Colorectal Surgery (2019) An update of the aims and achievements during the first year of the Young Group of the Italian Society of Colorectal Surgery (Y-SICCR). Tech Coloproctol 23(3):391

    Article  Google Scholar 

  28. Crohn BB, Ginzburg L, Oppenheimer GD (1932) Regional ileitis, a pathologic and clinical entity. J Am Med Assoc 99(16):1323

    Article  Google Scholar 

  29. Coffey JC, O’Leary DP, Kiernan MG et al (2016) The mesentery in Crohn’s disease: friend or foe? Curr Opin Gastroenterol 32(4):267

    Article  PubMed  Google Scholar 

  30. Mao R, Kurada S, Gordon IO, Baker ME, Gandhi N, McDonald C, Coffey J, Rieder F (2019) The mesenteric fat and intestinal muscle interface: creeping fat influencing stricture formation in Crohn's disease. Inflamm Bowel Dis 25(3):421

    Article  PubMed  Google Scholar 

  31. Buskens CJ, de Groof EJ, Bemelman WA, Wildenberg ME (2017) The role of the mesentery in Crohn's disease. Lancet 2(4):245

    Google Scholar 

Download references

Funding

No funding has been received for the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Colorectal Unit, Queen Alexandra Hospital – Portsmouth Hospitals NHS Trust, Portsmouth, UK

    V.Celentano & K. Flashman

  2. University of Portsmouth, Portsmouth, UK

    V.Celentano & M. Harper

  3. La Sapienza University, Rome, Italy

    E. Garofalo

  4. Humanitas Clinical and Research Center – IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy

    A. Spinelli

  5. Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy

    A. Spinelli

  6. Department of Advanced Medical and Surgical Sciences, Universitá Della Campania Luigi Vanvitelli, Naples, Italy

    G. Pellino & F. Selvaggi

  7. Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain

    M. Frasson

  8. Colon and Rectal Surgery Division, Humanitas University, Rozzano (Milan), Italy

    M. Carvello

  9. Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France

    N. de’Angelis

  10. Colorectal Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain

    A. Garcia-Granero

  11. Department of Colorectal Surgery, St Mark’s Hospital, Harrow, Middlesex, UK

    J. Warusavitarne

  12. Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK

    M. Coleman

  13. Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain

    E. Espin

Authors
  1. V.Celentano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Garofalo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Spinelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Pellino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K. Flashman
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Frasson
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Carvello
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. N. de’Angelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Garcia-Granero
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Harper
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J. Warusavitarne
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. Coleman
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. E. Espin
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. F. Selvaggi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Garofalo.

Ethics declarations

Disclosures

The authors Celentano V, Garofalo E, Spinelli A, Pellino G, Flashman K, Frasson M, Carvello M, de’Angelis N, Garcia-Granero A, Harper M, Warusavitarne J, Coleman M, Espin E, Selvaggi F, have no conflict of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 1120 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

V.Celentano, Garofalo, E., Spinelli, A. et al. Video-laparoscopic assessment of the small bowel in Crohn’s disease: a comparative study to evaluate surgeons’ inter-observer variability. Surg Endosc 35, 1378–1384 (2021). https://doi.org/10.1007/s00464-020-07521-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07521-8

Keywords

Search

Navigation