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Article Dans Une Revue Journal of Visceral Surgery Année : 2021

Post-surgical recurrence of crohn's disease: situational analysis and future prospects

Résumé

Surgery retains a major role in the treatment of Crohn's disease, and the prevention of post-operative recurrence is an essential issue. In fact, despite the increasing use of biotherapies, almost all of the patients who undergo surgery will present with a recurrence, initially endoscopic and then clinical, eventually leading to a second intervention in 15 to 20% of cases. Certain risk factors for recurrence such as smoking, repeated and/or extensive resections, anoperineal involvement, myenteric plexitis, epithelioid granulomas, penetrating disease behaviour and lack of post-operative prophylactic treatment have been well established. Currently, measures to prevent post-operative recurrence are based mainly on smoking cessation in all patients and the prescription of anti-TNFα medications for patients with a high risk of recurrence (at least two risk factors for recurrence). However, new surgical techniques have recently been described which could modify post-operative prevention strategies. Kono's lateral anti-mesenteric anastomosis could significantly reduce clinical and endoscopic recurrence compared to conventional anastomosis techniques. Long latero-lateral isoperistaltic stricturoplasties have been shown to be feasible and are associated with a low rate of long-term symptomatic recurrence requiring surgery. In a preliminary series, intestinal resections with extensive mesenteric resection reduced the rate of recurrence in comparison with patients operated on conventionally (3% vs. 40% at five years). If the results of these new surgical techniques are confirmed, the indications for post-operative immunomodulatory treatments could be downgraded in patients currently considered to be at high risk of recurrence.

Dates et versions

hal-04385114 , version 1 (10-01-2024)

Identifiants

Citer

Caroline Valibouze, Pierre Desreumaux, Philippe Zerbib. Post-surgical recurrence of crohn's disease: situational analysis and future prospects. Journal of Visceral Surgery, 2021, Journal of Visceral Surgery, 158, pp.401-410. ⟨10.1016/j.jviscsurg.2021.03.012⟩. ⟨hal-04385114⟩

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