Background
Mesentery thickening and enlarged lymphnodes are typical findings of Crohn's disease
(CD), but their role is unknown. Aim of the present study was to evaluate their prevalence
and significance on postoperative complications and long-term surgical recurrence
after CD surgery.
Methods
1272 consecutive, unselected patients were retrospectively reviewed, divided into
4 groups based on the presence or absence of a thickened mesentery and enlarged lymphnodes,
and stratified for primary or recurrent surgical procedure. In all patients but those
treated with strictureplasty the mesentery and lymphnodes were removed. Patients’
characteristics, peri-operative findings, and long-term recurrence were compared by
univariate and multivariate analysis.
Results
Thickened mesentery and enlarged lymphnodes were not present in all cases, were typical
of ileal location and penetrating behaviour, had a constant decrease over recurrences,
were independent of either pre-operative medical therapy or surgical approach, did
not increase the duration of surgery and complications, presented similar 20-years
recurrence rate to normal mesentery and lymphnodes. Lymphopathy was associated to
a worst nutritional status during disease recurrences. At multivariate analysis, age,
location, and behaviour, but not mesenteric characteristics, were related to an increased
risk of surgical recurrence.
Conclusions
This study provides new information on mesentery and lymphnodes in CD patients. Further
studies are needed to clarify the appropriate surgical approach.
Keywords
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Article info
Publication history
Published online: July 19, 2021
Accepted:
June 29,
2021
Received:
November 7,
2020
Footnotes
Thickened mesentery and enlarged lymphnodes are typical of ileal location and penetrating behavior, are independent of medical therapy nor surgical approach, do not increase the duration of surgery and complications, decrease over time, and have similar recurrence to normal mesentery and lymphnodes.
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.