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- Title
Surgical treatment of Crohn's disease - type of ileocolonic anastomosis and anastomotic leak rate.
- Authors
Mutafchyiski, V.; Popivanov, G.; Tabakov, M.; Kjossev, K.
- Abstract
Introduction Although the medical management is the mainstay treatment in Crohn's disease, about 70% of the patients will require surgery during their lifetime. Aim The aim of this study was to analyse our experience for the period 2004-2012 and to evaluate the influence of the type of the ileocolonic anastomosis on the anastomotic leak rate. Material and methods A retrospective analysis of 41 operated patients due to complicated Crohn's disease. Results The mean age of the included patients was 29.4 years (17-49), 31 males and 10 females. Sixty eight percent (n=28) of the cases were with ileocecal localisation. The types of operations performed was the following - 2 ileocecal resection, 26 right hemicolectomies, 4 strictureplasties, 4 small bowel resections, 1 sigmoid resection and adhesiolysis in 4. In the cases with ileocolonic localization, the surgery was indicated due to obstruction in 19 patients, high-output fistulas in 6 and abscess in 3. The mean hospital stay was 12.4 days (7-34). In 4 cases laparoscopic-assisted resection was performed with stapled side-to-side anastomosis. In the rest, the continuity of the gastrointestinal tract was performed by hand-sewn end-to-side anastomosis in 22 cases, side-to-side in 2. Anastomotic leak was noted in 1 case with side-to-side anastomosis (3.6%). Conclusions The surgery in Crohn's disease is indicated only to overcome the related complications. A more conservative approach to preserve sufficient length of the bowels is recommendable. In the case with ileocolonic resections hand-sewn T-L anastomosis can be a safe method, especially when is performed in high-volume centers. Laparoscopic resection is а reliable alternative of the open surgery, but requires considerable experience.
- Publication
Balkan Military Medical Review, 2015, Vol 18, Issue 2, p40
- ISSN
1107-6275
- Publication type
Article
- DOI
10.5455/bmmr.173840