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Surgery and Anesthesia 2018 & Euro Gastro Congress 2018

Case Reports in Surgery and Invasive Procedures

Volume 2

GASTROENTEROLOGY

International Conference on

SURGERY AND ANESTHESIA

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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

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.it

BIOGRAPHY