Shen WS, Huang XH, Liu RQ, Li CY, Li Y, Zhu WM. Perforating and nonperforating indications in repeated surgeries for Crohn’s disease. World J Clin Cases 2022; 10(9): 2733-2742 [PMID: 35434111 DOI: 10.12998/wjcc.v10.i9.2733]
Corresponding Author of This Article
Wei-Ming Zhu, MD, Chief Doctor, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. zhuweimingnj@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wei-Song Shen, Department of Gastrointestinal Surgery, Peking University People’s Hospital, Beijing 100044, China
Xiao-Hui Huang, Department of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing 100853, China
Rui-Qing Liu, Department of General Surgery, The affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
Chen-Yang Li, Peking University School of Nursing, Peking University School of Nursing, Beijing 100191, China
Yi Li, Wei-Ming Zhu, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, Jiangsu Province, China
Author contributions: Shen WS, Huang XH, and Liu RQ contributed equally to this work, studied conception and design, and drafting of manuscript; Li CY contributed to acquisition of data; Li Y analysis and interpretation of data; Zhu WM contributed to critical revision.
Supported byPeking University Medicine Fund of Fostering Young Scholars’ Scientific& Technological Innovation Supported by the Fundamental Research Funds for the Central Universities, No. BMU2021PYB009; Peking University People’s Hospital Research and Development Funds, No. RDY2020-14; National Natural Science Foundation of China, No. 82100546.
Institutional review board statement: This study was approved by the Jinling Hospital Ethics Committee. All methods were carried out in accordance with relevant guidelines and regulations.
Informed consent statement: All patients were contacted by telephone and asked to participate in the study. All patients gave informed written consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei-Ming Zhu, MD, Chief Doctor, Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. zhuweimingnj@163.com
Received: July 12, 2021 Peer-review started: July 12, 2021 First decision: December 17, 2021 Revised: December 27, 2021 Accepted: February 19, 2022 Article in press: February 19, 2022 Published online: March 26, 2022 Processing time: 253 Days and 2.3 Hours
Abstract
BACKGROUND
Despite advances in medical therapy for Crohn’s disease (CD), most patients with CD require repeated resection surgeries.
AIM
To analyze the perforating and nonperforating indications of repeated CD operations and identify the anastomosis characteristics for postoperative CD.
METHODS
We retrospectively reviewed 386 patients who underwent at least one resection for CD between 2003 and 2013.Clinical characteristics of each surgery were collected. Univariate and multivariate analyses were performed to determine risk factors for recurrence.
RESULTS
The indication for reoperation in CD tends to be the same as that for primary operation, i.e., perforating disease tends to represent as perforating disease and nonperforating as nonperforating. Concordance was found between the first surgery and second surgery in terms of the indication for the operation (P = 0.006), and the indication for the third surgery was also correlated with that for the second surgery (P = 0.033). Even if the correlation of surgical indications between repeated operations, the rate of perforating indication for the second and third surgeries was significantly higher than that of the first surgery. In addition, the presence of perforating CD was a predictor of recurrence for both the first and second surgeries. Moreover, anastomotic lesions were the most common sites of recurrence after the operation. Based on the importance of anastomosis, anastomosis might be a new type of disease location for the classification of postoperative CD.
CONCLUSION
CD not only has stable characteristics but also progresses chronically. Perforation is a progressive surgical indication for Crohn’s disease. For CD after surgery, anastomosis may be a new classification of disease location.
Core Tip: It was well-known that Crohn’s disease (CD) is a chronic disease characterized by progressive bowel destruction. Our findings suggest that CD becomes more severe and more extensive with the increase in number of surgeries. CD not only has stable characteristics, but also progresses chronically. Perforation is a progressive surgical indication for CD. For CD after operation, anastomosis may be a new classification of disease location.
