Comparison of index and reoperative bowel resections in Crohn's disease.

IF 1.8 4区 医学 Q2 SURGERY Minerva Surgery Pub Date : 2024-11-13 DOI:10.23736/S2724-5691.24.10339-5
Bradley Sherman, Syed A Farhan, Rami Aoun, Amber Traugott, Alan Harzman, Syed Husain
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Abstract

Background: There is a scarcity of literature describing outcomes of reoperative Crohn's disease. An in-depth knowledge of these outcomes is critical for managing patient expectations and optimal perioperative planning. We sought to examine outcomes in patients undergoing reoperative surgeries for Crohn's disease compared to index operations.

Methods: A retrospective chart review of surgeries performed from 2018-2023 at a single tertiary care academic institution was performed. A subgroup analysis of index vs. reoperative ileocolic resections was performed to minimize confounding due to the heterogeneity of operations between the index and reoperative groups.

Results: Out of 119 patients, 70 (59%) underwent index operations, and 49 (41%) were reoperations. Overall complication rates (24.28% vs. 34.69%, P=0.224), EBL (189.5 vs. 193.4 mL, P=0.94), operative time (209 vs. 236 min, P=0.091), length of stay (mean: 7.24 vs. 10.08 days, P=0.0142), utilization of laparoscopy (92.85% vs. 65.3%, P=0.0002) and conversion to open technique (4.61% vs. 9.37%, P=0.392) favored index cases. The laparoscopic approach narrowed the gap in length of stay between the index and reoperative groups from 2.83 to 0.6 days. Subgroup analysis of ileocolic resections (Index: 50, reoperations: 26) also favored the index operations.

Conclusions: The current study provides valuable insight into managing patient expectations and optimal perioperative planning for reoperative Crohn's disease. Reoperations were associated with longer stays, lower utilization of laparoscopic platforms, and a trend toward higher overall complication rates. Laparoscopy reduces the gap in length of stay between index and reoperations; however, it is associated with a higher reoperation conversion rate.

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克罗恩病的指数肠切除术和再手术肠切除术的比较。
背景:描述克罗恩病再手术效果的文献很少。深入了解这些结果对于管理患者期望值和制定最佳围手术期计划至关重要。我们试图研究克罗恩病再手术患者的疗效,并与指数手术进行比较:我们对一家三级医疗学术机构 2018-2023 年进行的手术进行了回顾性病历审查。对指数手术与再手术回结肠切除术进行了亚组分析,以尽量减少指数手术组与再手术组之间手术异质性造成的混杂因素:在119名患者中,70人(59%)接受了索引手术,49人(41%)接受了再手术。腹腔镜的使用率(92.85% 对 65.3%,P=0.0002)和改用开腹技术的比例(4.61% 对 9.37%,P=0.392)均优于指标病例。腹腔镜方法将指数组和再次手术组的住院时间差距从2.83天缩小到0.6天。回结肠切除术的分组分析(指数:50例,再次手术:26例)也倾向于指数手术:目前的研究为管理患者期望值和克罗恩病再手术的最佳围手术期规划提供了宝贵的见解。再次手术与住院时间较长、腹腔镜平台使用率较低以及总体并发症发生率较高有关。腹腔镜手术缩短了初次手术和再次手术之间的住院时间差距,但再次手术转换率较高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Minerva Surgery
Minerva Surgery SURGERY-
CiteScore
1.90
自引率
7.10%
发文量
320
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