Crohn Disease (CD), Crohn Disease of Ileum, Extended Mesenteric Excision, Kono S Anastomosis
Conditions
Keywords
Kono-s, extended mesenteric excision, mesenteric excision and exclusion
Brief summary
This study is designed for patients requiring surgery for Crohn's disease of the terminal ileum. A combination of laparoscopic segmental right colectomy with extended mesenteric excision and the Kono-s anastomosis will be utilized. Since this is a fairly new technique, the intra and post operative complications will be reviewed. Also endoscopic, clinical and surgical reoccurrence will be reviewed at certain predefined time points post operatively.
Detailed description
Crohn's disease is a chronic inflammatory disease that can affect any part of the gastrointestinal tract. The underlying etiology is still unknown, but it is perceived multifactorial and the effect of environmental and pathophysiological factors on a genetically predisposed individual. Although the development of new pharmacological agents has revolutionized the management of Crohn's disease, the rates of endoscopic and surgical reoccurrence still remain discouraging. It is estimated that 50% of patients with Crohn's disease will require surgical intervention and the rate of surgical reoccurrence remains as high as 30% at 10 years. Since most reoccurrences occur near or around the anastomotic site, the type of resection and anastomosis has been extensively reviewed in the past, but no significant differences have been observed. In the later years two new surgical techniques have been developed (extended mesenteric excision and Kono-S anastomosis), and increasing data show that they could potentially reduce the rate of reoccurrence. Both techniques focus on the role of the mesentery on disease reoccurrence. The extended mesenteric excision removes the mesentery and corresponding lymphatics of the affected bowel while the Kono-S anastomosis excludes the mesentery from the overlying wide anastomosis. The combination of the two techniques has been termed mesenteric excision and exclusion The primary goal of this study is to assess the safety the mesenteric excision and exclusion for Crohn's diseases disease of the terminal ileum in a central hospital of Greece. All intra and postoperative complications within 30 days will be collected and reviewed. As secondary goals, the endoscopic, clinical and surgical reoccurrence will be reviewed at 6 months, 2 years and 5 years after the operation.
Interventions
PROCEDUREMesenteric excision and exclusion
Laparoscopic segmental right colectomy and excision of the affected terminal ileum with extended mesenteric excision and open Kono-s anastomosis
Sponsors
Tzaneio General Hospital
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Males and females aged \>16 years * Ileocolic disease or disease of the terminal ileum with an indication for resection * Concurrent therapies with corticosteroids, 5-ASA drugs, thiopurines, MTX, antibiotics, and anti-TNF therapy are permitted. * All patients should have undergone a colonoscopy and a recent update of imaging (e.g. Ultrasound, MR enterography (or CT enterography if MR is contraindicated)) * Ability to comply with protocol. * Competent and able to provide written informed consent.
Exclusion criteria
* Inability to give informed consent. * Patients less than 16 years of age. * Clinically significant medical conditions within the six months before the operation : e.g. myocardial infarction, active angina, congestive heart failure or other conditions that would, in the opinion of the investigators, compromise the safety of the patient. * History of cancer \< 5 years which might influence patients prognosis * Emergent operation. * Pregnant or breast feeding. * Inability to follow up at 3, 6 and 12 months for postoperative assessment, imaging and endoscopy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Safety of the procedure | 30 days post intervention | Collection of intra and post operative complication rate |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Endoscopic reoccurence | 6 months, 2 years and 5 years post intervention | Endoscopic reoccurrence according to Rutgeert's score |
| Clinical reoccurrence | Up to 5 years | Clinical symptoms severe enough to require new endoscopy |
| Surgical reoccurrence | Up to 5 years | Repeat surgery because of reoccurrence at the proximity of the Kono-S anastomosis |
Countries
Greece
Contacts
Primary ContactPanagiotis Dikeakos, Consultant
Outcome results
None listed