EXTENDED VERSUS LIMITED MESENTERIC EXCISION IN BOWEL RESECTION FOR CROHN’S DISEASE: A META-ANALYSIS AND SYSTEMATIC REVIEW

Background There is controversy regarding the extended excision of the mesentery in intestinal resection for Crohn’s disease (CD). Some studies suggest that extended mesenteric excision (EME) can reduce the surgical recurrence of the disease compared with limited mesenteric excision (LME).

Objective We aimed to perform a systematic review and meta-analysis comparing EME and LME for CD.

Methods We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and EMBASE for studies published until April 2024. Odds ratios (OR) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the Cochran Q test and I² statistics, with p-values < 0.10 and I²> 25% considered significant. Statistical analysis was performed using R Software, version 4.1.2.

Results A total of 5 observational studies were included, comprising 4,365 patients; 992 (22.7%) underwent EME and 3,373 (77.2%) to LME. No significant differences were observed between EME and LME in overall postoperative complication, Clavien-Dindo ≥ 3, bleeding that needed transfusion, anastomotic leak, intrabdominal abscess, SSI, reoperations, readmission, and ileus. EME was associated with a decrease in surgical recurrence compared with LME (OR 0.31; 95% CI 0.12 to 0.84; p = 0.021).

Conclusion In this meta-analysis of patients with CD who underwent intestinal resection, EME was associated with a significant reduction in surgical recurrence compared with LME, without a significant difference in complication rates.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025