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Page 37
N o v e m b e r 1 2 - 1 3 , 2 0 1 8 | R o m e , I t a l y
Joint Event on
OF EXCELLENCE
IN INTERNATIONAL
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alliedacademies.comYEARS
Surgery and Anesthesia 2018 & Euro Gastro Congress 2018
Case Reports in Surgery and Invasive Procedures
|
Volume 2
&
GASTROENTEROLOGY
3
rd
International Conference on
SURGERY AND ANESTHESIA
International Conference on
Rosario Fornaro et al., Case Rep Surg Invasive Proced 2018, Volume 2
SURGERY OF CROHN’S DISEASE: DOES THE
TYPE OF ANASTOMOSIS AND RESECTION
REALLY PLAY A ROLE IN THE PROPHYLAXIS
OF POSTOPERATIVE RECURRENCE?
Rosario Fornaro, Andrea Razzore, Marco Casaccia, Emanuela
Stratta, Giuseppe Caristo
and
Marco Frascio
Università di Genova, Italy
C
rohn’s Disease (CD) is a chronic intestinal inflammatory disease associat-
ed with high rates of postoperative recurrence (POR). More than 75% of
patients undergo at least one surgery. Moreover, in a large number of cases
the disease recurs and the risk of undergoing a new intervention is estimated
at around 1.5% per year. The observation that patients with definitive ileos-
tomy rarely have relapses and that in 90% of cases they are located in the
pre-anastomotic tract, leads us to suppose that the type of anastomosis can
play a role in the appearance of POR.
Purpose:
To focus the role of surgery in reducing the incidence of ROP, with
particular reference to the size of intestinal resection and the type of anas-
tomosis.
Methods:
Review of the literature of the last two decades and critical analysis
of one’s own experience.
Results:
The extent of intestinal resection and the type of anastomosis have
been the subject of numerous studies. The extent of the resection margin has
no influence on recurrence rates. Therefore, the extended resections should
be avoided: A macroscopically normal margin of 2 cm is adequate and the
presence of microscopic residual disease at the resection margins does not
lead to a significant increase in the incidence of recurrences. The rate of re-
lapse would be lower in cases where the anastomotic configuration is such
as to present a broad wide, as in the case of latero-lateral anastomosis (SSA),
rather than a narrow lumen, as in the termino-thermal anastomosis (EEA). It
appears that the rates of relapse after SSA are lower, especially if the anas-
tomosis is performed with stapler (stapled side-to-side anastomosis-SSSA)
compared to that performed manually (handswen end-to-end anastmo-
sis-HEEA).
Conclusions:
The role of the different resection techniques and of the dif-
ferent types of anastomoses remains uncertain today and it is not possible
to establish the effectiveness in preventing recurrences. Further large-scale
controlled studies with long-term follow-up are needed.
Rosario Fornaro completed his degree in medicine and
surgery specialization in general surgery, surgery of di-
gestive apparatus and digestive endoscopy, vascular sur-
gery. He is currently working at Università di Genova, Italy.
rfornaro@unige.itBIOGRAPHY