Le resezioni di minima per Morbo di Crohn: valutazione di alcuni fattori di rischio di recidiva

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F. BOTTI, A. CARRARA, B. ANTONELLI, F. QUADRI, M.MAINO, B. CESANA, E. CONTESSINI-AVESANI

Ann. Ital. Chir., LXXIV, 6, 2003

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Objective: To assess the effect of disease pattern and involment
of the margins on early and late results of enteric
resections with hand-sewn anastomosis for Crohn’s disease.
Background: Bowel sparing is one of the aims of the surgery
for CD. When strictureplasties are not possible, “minimal
surgery” (the resection just of the grossly involved tract
of bowel) is the current choice.
Methods: One hundred and forty-six cases of resections in
128 patients were performed in the years 1991-2001. We
investigated if there is a relationship between disease pattern
(perforating and non-perforating) or hystologic involvement
of the margins and recurrence (reoperation for recurrent
preanastomotic disease). Hand-sewn anastomosis were
performed almost in all the cases; we compared the results
with the main series of stapled and hand-sewn sutures.
Results: Nine surgical complications occurred (7%), requiring
six relaparotomies and three conservative treatments.
Overall rate of recurrence (median follow-up 44 months)
is 17%: 9% in patients with non perforating disease and
19% in patients with perforating disease. The rate of recurrence
is 6% in the group of patients with involved margins
and 23% in the group with non involved margins.
Conclusions: Limited surgery for CD doesn’t increase rate
of recurrence; the involvement of margins is not a risk factor
for early reoperation. Hand-sewn anastomosis seem to
be as safe as stapled ones.

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