Surgical management of complex ileocolonic Crohn's disease : a survey of IBD colorectal surgeons to assess variability in operative strategy
Garofalo, E.. (La Sapienza University.)
Selvaggi, F. (Universitádella Campania "Luigi Vanvitelli")
Spinelli, A. (Humanitas Research Hospital (Itàlia))
Pellino, Gianluca (Universitádella Campania "Luigi Vanvitelli")
Flashman, K. (Queen Alexandra Hospital (Portsmouth, Regne Unit))
Frasson, M. (Hospital Universitari i Politècnic La Fe (València))
Carvello, M. (Humanitas University.)
de'Angelis, Nicola (Université Paris-Est)
Garcia-Granero, A. (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Harper, M. (University of Portsmouth)
Warusavitarne, J. (St Mark's Hospital (Londres))
Coleman, M. (University Hospitals Plymouth NHS Trust (Regne Unit))
Espin, E. (Hospital Universitari Vall d'Hebron)
Celentano, Valerio (Imperial College)
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	To explore the reported variability in the surgical management of ileocolonic Crohn' s disease and identify areas of standard practice, we present this study which aims to assess how different colorectal surgeons with a subspecialty interest in inflammatory bowel disease (IBD) surgery may act in different clinical scenarios of ileocolonic Crohn's disease. Anonymous videos demonstrating the small bowel walkthrough and anonymised patients' clinical data, imaging and pathological findings were distributed to the surgeons using an electronic tool. Surgeons answered on operative strategy, bowel resections, management of small bowel mesentery, type of anastomosis and use of stomas. Eight small bowel walkthrough videos were registered and 12 assessors completed the survey with a questionnaire completion rate of 87. 5%. There was 87. 7% agreement in the need to perform an ileocolonic resection. However, the agreement for the need to perform associated surgical procedures such as strictureplasties or further bowel resections was only 57. 4%. When an anastomosis was fashioned, the side to side configuration was the most commonly used. The preferred management of the mesentery was dissection close to the bowel. The decision on the main procedure to be performed had a high agreement amongst the different assessors, but the treatment of multifocal disease was highly controversial, with low agreement on the need for associated procedures to treat internal fistulae and the use of strictureplasties. At the same time, there was significant heterogeneity in the decision on when to anastomose and when to fashion an ileostomy. The online version contains supplementary material available at 10. 1007/s00384-021-03892-z.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Crohn's disease ; Laparoscopic surgery ; Colorectal surgery ; Ileocaecal resection ; Inflammatory bowel disease
Published in:	International Journal of Colorectal Disease, Vol. 36 (february 2021) , p. 1811-1815, ISSN 1432-1262

DOI: 10.1007/s00384-021-03892-z
PMID: 33629119

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