ISSN: 1300-0292
İndekslendiği Dizinler: SCIENCE CITATION INDEX EXPANDED
CINAHL, Index Copernicus,
Chemical Abstracts (CA),
Excerpta Medica / EMBASE
Dil: Türkçe, İngilizce
İçerik: Orijinal Araştırma, Derleme, Editöre Mektup, Olgu Sunumu, Tıp Eğitimi, Tıbbi Kitap İncelemeleri
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ORIGINAL RESEARCH ARTICLES |
The Impact Of Anastomosis On Crohn’s Disease Recurrence: Conventional Vs. Wide Lumen Anastomosis
Gürel NEŞŞAR, MD,a Ali Eba DEMİRBAĞ, MD,a Taner ORUĞ, MD, a
Orhan ELBİR, MD, a T. Metin ŞAVKILIOĞLU, MD, a Fuat ATALAY, MDa
aDepartment of Gastrointestinal Surgery Department, Türkiye Yüksek İhtisas Hospital, ANKARA
Objective: It is well recognized that Crohn’s disease recurs after surgical resection. There are many factors leading to recurrence. Among them, the diameter of the anastomosis is the only variable that may be controlled. The aim of this study was to determine whether a wide-lumen anastomosis provides better outcome than conventional anastomoses.
Material and Methods: Between 2003 and 2004, a total of 18 patients (15 M, 3 F; mean age 37.0 ± 10.8; range 19-55) underwent 19 ileal, ileocolic, or colonic resections due to Crohn’s disease complications. The patients were divided into two groups. In the first group, conventional hand-sewn end-to-end or end-to-side anastomoses with a 3 cm diameter were fashioned in 9 patients. In the second group, 10 wide lumen anastomoses with a diameter of 9 cm, hand-sewn or stapled, were constructed in 9 patients. Independent variables were age, gender, localization, phenotype and the type of anastomosis. Dependent variables were recurrence, reoperation, and disease-free survival. Chi-square, Fisher’s exact, Student’s t, and Mann-Whitney U tests were used for statistical analyses.
Results: Mean follow-up period was 30.2 ± 5.8 months (range: 18.7-40.6). There were four recurrences in the conventional group of patients and two of them underwent reoperation. None of the wide-lumen group of patients recurred. The difference in recurrence rate between the two groups was statistically significant (p= 0.033). There were no significant differences between the two groups with respect to age, gender, localization, phenotype of disease and follow-up period.
Conclusions: Our results suggest that wide lumen anastomosis is as safe as conventional anastomosis, and results in a lower recurrence of Crohn’s disease without increasing morbidity. Well-designed prospective randomized studies are necessary for further evaluation.Keywords: Crohn disease, anastomosis, surgical, recurrenceTurkiye Klinikleri J Med Sci 2006, 26:630-633
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