A Reappraisal of Outcome of Elective Surgery After Successful Non-Operative Management of an Intra-Abdominal Abscess Complicating Ileocolonic Crohn’s Disease: A Subgroup Analysis of a Nationwide Prospective Cohort

Autor: R Souche, Eddy Cotte, Philippe Zerbib, Stéphane Benoist, Léon Maggiori, Jérôme Loriau, Adeline Germain, Guillaume Meurette, L Beyer-Berjot, Amine Rahili, Karine Pautrat, V Bridoux, Jean-Pierre Duffas, Yves Panis, Jérémie H. Lefevre, J. L. Faucheron, Eric Vicaut, Q Denost, M K Collard, Véronique Desfourneaux, Antoine Brouquet, H Corté, Christine Denet
Přispěvatelé: Service de Chirurgie générale et digestive [CHU Le Kremlin-Bicêtre], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Beaujon [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service des Maladies de l'Appareil Digestif et de la Nutrition [CHRU Lille], Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Saint-André [CHU de Bordeaux], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre Hospitalier Lyon Sud, Service de Chirurgie Digestive, Hospices Civils de Lyon (HCL), CHU Marseille, Hopital Saint-Louis [AP-HP] (AP-HP), Centre Hospitalier Universitaire de Rennes (CHU Rennes), Centre Hospitalier Universitaire de Nice (CHU Nice), CHU Toulouse [Toulouse], Service de Chirurgie d'Oncologie Digestive [CHU Lariboisière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Institut Mutualiste de Montsouris (IMM), Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau (ADEN), Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), UNIROUEN - UFR Santé (UNIROUEN UFR Santé), Normandie Université (NU)-Normandie Université (NU), Service de chirurgie digestive [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Centre hospitalier universitaire de Nantes (CHU Nantes), Centre Hospitalier Universitaire [Grenoble] (CHU), Service de Chirurgie digestive [GH Paris Saint-Joseph], Centre hospitalier Saint-Joseph [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
Rok vydání: 2020
Předmět:
Adult
Male
medicine.medical_specialty
Abdominal Abscess
ileocolonic resection
Adolescent
Matched-Pair Analysis
Preoperative care
Cohort Studies
Young Adult
03 medical and health sciences
0302 clinical medicine
Crohn Disease
intra-abdominal abscess
Recurrence
medicine
Humans
Elective surgery
10. No inequality
Abscess
Prospective cohort study
Aged
Aged
80 and over
Crohn's disease
Nutritional Support
business.industry
Gastroenterology
[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology
Intra-abdominal Abscess
General Medicine
Middle Aged
bacterial infections and mycoses
medicine.disease
Anti-Bacterial Agents
3. Good health
Surgery
Elective Surgical Procedures
030220 oncology & carcinogenesis
Propensity score matching
Drainage
Female
030211 gastroenterology & hepatology
France
ileocolonic Crohn’s disease
business
Zdroj: Journal of Crohn's & Colitis
Journal of Crohn's & Colitis, Oxford University Press 2020, ⟨10.1093/ecco-jcc/jjaa217⟩
ISSN: 1876-4479
1873-9946
DOI: 10.1093/ecco-jcc/jjaa217
Popis: Background and AimsFew prospective data exist on outcomes of surgery in Crohn’s disease [CD] complicated by an intra-abdominal abscess after resolution of this abscess by antibiotics optionally combined with drainage.MethodsFrom 2013 to 2015, all patients undergoing elective surgery for CD after successful non-operative management of an intra-abdominal abscess [Abscess-CD group] were selected from a nationwide multicentre prospective cohort. Resolution of the abscess had to be computed tomography/magnetic resonance-proven prior to surgery. Abscess-CD group patients were 1:1 matched to uncomplicated CD [Non-Penetrating-CD group] using a propensity score. Postoperative results and long-term outcomes were compared between the two groups.ResultsAmong 592 patients included in the registry, 63 [11%] fulfilled the inclusion criteria. The abscess measured 37 ± 20 mm and was primarily managed with antibiotics combined with drainage in 14 patients and nutritional support in 45 patients. At surgery, a residual fluid collection was found in 16 patients [25%]. Systemic steroids within 3 months before surgery [p = 0.013] and the absence of preoperative enteral support [p = 0.001] were identified as the two significant risk factors for the persistence of a fluid collection. After propensity score matching, there was no significant difference between the Abscess-CD and Non-Penetrating-CD groups in the rates of primary anastomosis [84% vs 90% respectively, p = 0.283], overall [28% vs 15% respectively, p = 0.077] and severe postoperative morbidity [7% vs 7% respectively, p = 1.000]. One-year recurrence rates for endoscopic recurrence were 41% in the Abscess-CD and 51% in the Non-Penetrating-CD group [p = 0.159].ConclusionsSurgery after successful non-operative management of intra-abdominal abscess complicating CD provides good early and long-term outcomes.
Databáze: OpenAIRE
Externí odkaz: