Post-surgical recurrence of Crohn's disease: Situational analysis and future prospects

• Published in: Journal of visceral surgery 2021-10, Vol.158 (5), p.401-410
• Main Authors: Valibouze, C., Desreumaux, P., Zerbib, P.
• Format: Article
• Language: English
• Subjects: Anastomosis; Crohn's disease; Ileocecal resection; Life Sciences; Recurrence
• ISSN: 1878-7886; 1878-7886
• DOI: 10.1016/j.jviscsurg.2021.03.012

•30–50% of patients with Crohn's disease will require surgery during their lifetime in order to resolve obstructive symptoms in the more or less long term. However, almost all patients develop endoscopic recurrence post-operatively; its detection is essential since it precedes the development of clinical recurrence that may require surgery. Eventually, 15–20% of resected patients will require a new intestinal resection.•Several risk factors have been implicated in post-operative recurrence: smoking, repeated and/or extensive resections (>50cm), anoperineal involvement, myenteric plexitis, epithelioid granulomas and lack of post-operative prophylactic treatment. The penetrating phenotype of Crohn's disease, classically recognized as promoting post-operative recurrence, has more recently been identified as a protective factor against recurrence.•Currently, the prevention of recurrence requires the cessation of smoking in all cases and the prescription of anti-TNF to patients at high risk of recurrence (at least two risk factors). However, the effectiveness of anti-TNF agents is limited and diminishes over time.•The consensus of ECCO (European Crohn's and Colitis Organization) favors a lateral stapled anastomosis for ileocecal resection and considers stricturoplasty as a valid alternative to resection for short or long strictures of the small intestine except for perforating disease where only resections are possible. Long stricturoplasty techniques for extensive strictures have provided encouraging results with regard to endoscopic healing and long-term surgical recurrence.•The side-to-side Kono anastomosis and intestinal resections that include extensive mesenteric resection have shown promising results leading to decreased endoscopic, clinical and surgical recurrence. These new techniques could thus limit the need for post-operative prescription of immunomodulators in patients considered to be at high risk of recurrence. 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, penetrati