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    Laparoscopic surgery for complex and recurrent Crohn's disease
    (BAISHIDENG PUBLISHING GROUP INC, 2017-01-01) Sevim, Yusuf; Akyol, Cihangir; Aytac, Erman; Baca, Bilgi; Bulut, Orhan; Remzi, Feza H.
    Crohn's disease (CD) is a chronic inflammatory disease of digestive tract. Approximately 70\% of patients with CD require surgical intervention within 10 years of their initial diagnosis, despite advanced medical treatment alternatives including biologics, immune suppressive drugs and steroids. Refractory to medical treatment in CD patients is the common indication for surgery. Unfortunately, surgery cannot cure the disease. Minimally invasive treatment modalities can be suitable for CD patients due to the benign nature of the disease especially at the time of index surgery. However, laparoscopic management in fistulizing or recurrent disease is controversial. Intractable fibrotic strictures with obstruction, fistulas with abscess formation and hemorrhage are the surgical indications of recurrent CD, which are also complicating laparoscopic treatments. Nevertheless, laparoscopy can be performed in selected CD patients with safety, and may provide better outcomes compared to open surgery. The common complication after laparoscopic intervention is postoperative ileus seems and this may strongly relate excessive manipulation of the bowel during dissection. But additionally, unsuccessful laparoscopic attempts requiring conversion to open surgery have been a major concern due to presumed risk of worse outcomes. However, recent data show that conversions do not to worsen the outcomes of colorectal surgery in experienced hands. In conclusion, laparoscopic treatment modalities in recurrent CD patients have promising outcomes when it is used selectively.
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    Impact of intestinal ultrasound with a portable system in the management of Crohn's disease
    (OXFORD UNIV PRESS, 2021-01-01) Gonen, Can; Surmelioglu, Ali; Kochan, Koray; Ozer, Serhat; Aslan, Ekrem; Tilki, Metin
    Background: Intestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn's disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients. Methods: A total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients' clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD). Results: The initial clinical-management decision was changed in 47 patients (40.2\%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2\% to 90.6\% in comparison to reference decisions (P < 0.001). After IUS examination, a further 13 cases (11.1\%) were identified for urgent surgical/interventional procedures. The accuracy of colonoscopic (SES-CD >= 3) assessment was shown to be comparable to that of IUS (94\% vs 91\%). The sensitivity for disease presence was 95\% with colonoscopy and 94\% with the IUS assessment. Conclusion: IUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.
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    Surgery for Intestinal Crohn's Disease: Results of a multidisciplinary approach
    (TURKISH SURGICAL ASSOC, 2018-01-01) Atasoy, Deniz; Aghayeva, Afag; Aytac, Erman; Erenler, Ilknur; Celik, Aykut Ferhat; Baca, Bilgi; Karahasanoglu, Tayfun; Hamzaoglu, Ismail
    Objectives: Crohn's disease is a chronic inflammatory bowel disease that requires lifelong multidisciplinary management. Seventy percent of patients affected by Crohn's disease will require at least one surgical procedure over their lifetime. The aim of this retrospective study was to present our series of patients suffering from Crohn's disease who were scheduled for surgery by a multidisciplinary team. Material and methods: The data were retrieved from a review of 950 patients with Crohn's disease treated at our institution between March 2000 and March 2016. Only patients with intestinal Crohn's disease were included into the study. A multidisciplinary team assessed the decision to perform surgery. Results: There were 203 patients who underwent surgery included in this study. One hundred and sixty-six were intestinal and 37 were perianal Crohn's disease. The mean age was 36 +/- 11.5 (range, 12-75) years. Ninety-two were stricturing, 45 were fistulizing, and 12 were inflammatory. The most commonly affected site was the ileocecal region (n=109, 65.7\%), and the most common surgical procedure was the ileocecal resection (n=109, 65.6\%). Laparoscopic approach was the procedure of choice in 56 (33.7\%) patients. Of the patients enrolled, the most common early (<30 days) complications observed were the wound infection as the first (n=11) and anastomotic leak as the second (n=10). The mortality rate was 2.4\% (n=4). Conclusion: Multidisciplinary approach to Crohn's disease may decrease the surgical complications and recurrence rates leading to a better treatment.