Microscopic inflammation in ileocecal specimen does not correspond to a higher anastomotic leakage rate after ileocecal resection in Crohn’s disease
| Autor: | Claudia Seifarth, Martin E. Kreis, Andrea Ullrich, Benjamin Weixler, Christian Schineis, Kai S. Lehmann, Johannes C. Lauscher, Christoph Holmer |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Epidemiology Health Care Providers Crohn's Disease Anastomotic Leak 0302 clinical medicine Crohn Disease Intestine Small Medicine and Health Sciences Medical Personnel Laparoscopy Immune Response Crohn's disease Multidisciplinary medicine.diagnostic_test Anastomosis Surgical Margins of Excision Middle Aged Professions 030220 oncology & carcinogenesis Resection margin Medicine Female 030211 gastroenterology & hepatology medicine.symptom Research Article Adult medicine.medical_specialty Adolescent Science Immunology Surgical and Invasive Medical Procedures Inflammation Gastroenterology and Hepatology Anastomosis Autoimmune Diseases Young Adult 03 medical and health sciences Signs and Symptoms Physicians medicine Humans Intestine Large Aged Retrospective Studies Surgeons Frozen section procedure Surgical Resection business.industry Inflammatory Bowel Disease Biology and Life Sciences Retrospective cohort study Perioperative medicine.disease Surgery Health Care Medical Risk Factors People and Places Clinical Immunology Population Groupings Clinical Medicine business |
| Zdroj: | PLoS ONE, Vol 16, Iss 3, p e0247796 (2021) PLoS ONE |
| ISSN: | 1932-6203 |
| Popis: | Background Patients with Crohn’s disease suffer from a higher rate of anastomotic leakages after ileocecal resection than patients without Crohn’s disease. Our hypothesis was that microscopic inflammation at the resection margins of ileocecal resections in Crohn’s disease increases the rate of anastomotic leakages. Patients and methods In a retrospective cohort study, 130 patients with Crohn’s disease that underwent ileocecal resection between 2015 and 2019, were analyzed. Anastomotic leakage was the primary outcome parameter. Inflammation at the resection margin was characterized as “inflammation at proximal resection margin”, “inflammation at distal resection margin” or “inflammation at both ends”. Results 46 patients (35.4%) showed microscopic inflammation at the resection margins. 17 patients (13.1%) developed anastomotic leakage. No difference in the rate of anastomotic leakages was found for proximally affected resection margins (no anastomotic leakage vs. anastomotic leakage: 20.3 vs. 35.3%, p = 0.17), distally affected resection margins (2.7 vs. 5.9%, p = 0.47) or inflammation at both ends (9.7 vs. 11.8%, p = 0.80). No effect on the anastomotic leakage rate was found for preoperative hemoglobin concentration (no anastomotic leakage vs. anastomotic leakage: 12.3 vs. 13.5 g/dl, p = 0.26), perioperative immunosuppressive medication (62.8 vs. 52.9%, p = 0.30), BMI (21.8 vs. 22.4 m2/kg, p = 0.82), emergency operation (21.2 vs. 11.8%, p = 0.29), laparoscopic vs. open procedure (p = 0.58), diverting ileostomy (31.9 vs. 57.1%, p = 0.35) or the level of surgical training (staff surgeon: 80.5 vs. 76.5%, p = 0.45). Conclusion Microscopic inflammation at the resection margins after ileocecal resection in Crohn’s disease is common. Histologically inflamed resection margins do not appear to affect the rate of anastomotic leakages. Our data suggest that there is no need for extensive resections or frozen section to achieve microscopically inflammation-free resection margins. |
| Databáze: | OpenAIRE |
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