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“Mesentery-based surgery” to prevent surgical recurrence in Crohn’s disease: from basics to surgical practice

  • Roberto Peltrini
  • L. Bucci
Letter to the Editor

Dear Editor:

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 [1]. 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...

References

  1. 1.
    Coffey JC, O’Leary DP (2016) The mesentery: structure, function, and role in disease. Lancet Gastroenterol Hepatol 1(3):238–247.  https://doi.org/10.1016/S2468-1253(16)30026-7 CrossRefPubMedGoogle Scholar
  2. 2.
    Coffey JC, O’Leary DP, Kiernan MG, Faul P (2016) The mesentery in Crohn’s disease: Friend or foe? Curr Opin Gastroenterol 32(4):267–273.  https://doi.org/10.1097/MOG.0000000000000280 CrossRefPubMedGoogle Scholar
  3. 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 CrossRefPubMedGoogle Scholar
  4. 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 CrossRefPubMedGoogle Scholar
  5. 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
  6. 6.
    Li Y, Zhu W, Gong J, Zuo L, Zhang W, Gu L, Guo Z, Cao L, Li N, Li J (2014) Influence of exclusive enteral nutrition therapy on visceral fat in patients with Crohn’s disease. Inflamm Bowel Dis 20(9):1568–1574.  https://doi.org/10.1097/MIB.0000000000000114 CrossRefPubMedGoogle Scholar
  7. 7.
    Li Y, Zhu W, Gong J, Zhang W, Gu L, Guo Z, Cao L, Shen B, Li N, Li J (2015) Visceral fat area is associated with a high risk for early postoperative recurrence in Crohn’s disease. Color Dis 17(3):225–234  https://doi.org/10.1111/codi.12798 CrossRefGoogle Scholar
  8. 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 CrossRefGoogle Scholar
  9. 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

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of General and Specialist SurgeryUniversity of Naples Federico IINaplesItaly

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