About this Medicine article
Comment on Holubar et al “Mesenteric Excision and Exclusion for Ileocolic Crohn’s Disease: Feasibility and Safety of an Innovative, Combined Surgical Approach With Extended Mesenteric Excision and Kono-S Anastomosis” by Steven R. Brown; Laura Hancock; Marie Hyslop; Jamie M. Hall; Danny Hind is a Medicine article available to read on EtoBox.
To the Editor-We congratulate Holubar et al 1 on their work combining extended mesenteric excision (EME) with Kono-S anastomosis. Crohn's disease recurrence after surgery is common. Surgeons are desperate to reduce this recurrence, which is why these approaches are so appealing. 2,3 However, while an astounding reduction in recurrence with both techniques is reported, the data, particularly for EME, are not strong. Even randomized clinical trial evidence for Kono-S 4 has detractors.Safety is essential, but there are concerns regarding EME. The authors highlight the risk of high ligation of the ileocolic vessels in the presence of inflamed mesentery. Furthermore, they do not advocate an "over aggressive approach" to the mesentery, slightly contradicting the aim of the report. We question why ileocolic vessel ligation is required at all. If the principle of EME is removal of the mesentery as the driver of recurrence, it is as effective and safer to resect mesentery radically while preserving the ileocolic vessels. This has the additional benefit of minimizing colonic excision, as preservation of the bowel is essential in Crohn's disease.The mesentery driving Crohn's disease recurrenc
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- Author
- Steven R. Brown; Laura Hancock; Marie Hyslop; Jamie M. Hall; Danny Hind
- Published
- 2022
- Language
- EN
- Field
- Medicine (Health Sciences)