Luglio Gaetano, Kono Toru
Department of Medical and Surgical Gastrointestinal Diseases, Endoscopic Surgery Unit, School of Medicine, University of Naples Federico II, Naples, Italy.
Advanced Surgery Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.
Inflamm Intest Dis. 2021 May 21;7(1):21-27. doi: 10.1159/000515372. eCollection 2022 Jan.
Since its first description, the role of surgery in Crohn's disease (CD) has always been controversial; in fact, it has been mainly considered as a gastroenterological disease for long time. Nevertheless, despite great advances in medical therapy, up to 70-80% of patients with CD will require surgery in their lifetime and up to 30% of them will undergo repeated surgeries due to recurrences. For these reasons, the idea of surgery as a tool in the therapeutic armamentarium to consider even in the early stage of the disease has progressively spread in the last decades, even corroborated by reports showing how primary surgery is able to definitively treat around half of the patients at long-term follow-up. More surgeons are nowadays more and more involved in developing techniques to reduce recurrences that have always been considered as part of the natural history of the disease so far.
In this review, we will go through the role of surgery in the management of CD, showing the potential benefits of an early surgical approach as well as the impact of surgical research in the natural history of the disease. From this standpoint, we will show the role of different anastomotic configurations, emphasizing how more and more data are definitively establishing the impact of the novel Kono-S anastomosis in reducing endoscopic and surgical recurrence. Mesentery-based surgery is a novel and appealing surgical perspective, but more data are required.
Surgery has demonstrated to be a crucial tool in the therapeutic armamentarium for the management of CD. Early surgery and novel surgical techniques, such as the Kono-S anastomosis, may have an impact on the natural history of the disease, including the possibility to prevent recurrences.
自首次被描述以来，手术在克罗恩病（CD）中的作用一直存在争议；事实上，长期以来它主要被视为一种胃肠病。然而，尽管药物治疗取得了巨大进展，但高达70 - 80%的CD患者在其一生中需要手术，其中高达30%的患者会因复发而接受多次手术。由于这些原因，在过去几十年里，将手术视为甚至在疾病早期就可纳入治疗手段的想法逐渐传播开来，一些报告也证实了这一点，这些报告显示初次手术在长期随访中能够明确治愈约一半的患者。如今，越来越多的外科医生参与开发减少复发的技术，而复发一直被认为是该病自然病程的一部分。
在本综述中，我们将探讨手术在CD管理中的作用，展示早期手术方法的潜在益处以及手术研究对疾病自然病程的影响。从这个角度出发，我们将展示不同吻合构型的作用，强调越来越多的数据如何明确证实新型Kono - S吻合术在减少内镜及手术复发方面的影响。基于肠系膜的手术是一种新颖且有吸引力的手术思路，但还需要更多数据。
手术已被证明是CD管理治疗手段中的关键工具。早期手术和新型手术技术，如Kono - S吻合术，可能会对疾病的自然病程产生影响，包括预防复发的可能性。
