Our Summary

This study looked at the rates of incisional hernia (a type of hernia that occurs after surgery in the area of a surgical wound) in patients with Crohn’s disease who had undergone two types of bowel surgery: open surgery and laparoscopic surgery (a less invasive type of surgery that uses small incisions).

The researchers examined the medical records of 750 patients with Crohn’s disease who had these surgeries at the Mount Sinai Medical Center in New York. They compared 500 patients who had open surgery with 250 patients who had laparoscopic surgery.

They found that patients who had open surgery had a higher average age when their disease started and when they had surgery, had been sick for a longer time, had lower levels of a certain protein in their blood, had more previous surgeries, were more likely to be taking steroids, needed more blood transfusions, and were more likely to need a certain procedure during their surgery.

However, the rate of incisional hernia was almost the same in both groups after 36 months. About 16% of the patients who had laparoscopic surgery needed to be switched to open surgery, and these patients had the highest rate of incisional hernia at 18%.

The researchers also found that the length of the surgical cut was significantly linked to the rate of incisional hernia. Patients who had laparoscopic surgery with certain techniques and smaller incisions did not get incisional hernia.

The researchers concluded that using advanced laparoscopic techniques that involve certain procedures and smaller incisions could greatly reduce or even eliminate the risk of incisional hernia in patients with Crohn’s disease who have bowel surgery.

FAQs

  1. What is the rate of incisional hernia occurrence in patients with Crohn’s disease who undergo open bowel resection compared to those who undergo laparoscopic bowel resection?
  2. What factors were found to correlate with a higher incidence of incisional hernia in patients with Crohn’s disease after bowel resection surgery?
  3. How can the risk of incisional hernia be reduced in patients with Crohn’s disease undergoing bowel resection?

Doctor’s Tip

A helpful tip a doctor might tell a patient about bowel resection is to consider laparoscopic surgery with intra-abdominal anastomosis and small transverse extraction incisions in order to decrease the risk of developing an incisional hernia. This technique has been shown to significantly reduce or even eliminate the occurrence of incisional hernias in patients with Crohn’s disease undergoing bowel resection.

Suitable For

Patients with Crohn’s disease who require bowel resection are typically recommended for surgery if they have complications such as strictures, fistulas, abscesses, or bowel obstructions that do not respond to medical treatment. Additionally, patients with Crohn’s disease who have failed multiple medical therapies or have recurrent flares may also be recommended for bowel resection. Other factors that may indicate the need for bowel resection include significant weight loss, malnutrition, and complications such as perforation or bleeding.

Timeline

  • Before bowel resection: Patients with Crohn’s disease may have a history of multiple previous surgeries, be on steroids, have low serum albumin levels, and may require blood transfusions. They may also have a longer duration of disease and may need an ileostomy during resection.

  • During bowel resection: Patients may undergo either open or laparoscopic surgery. Patients undergoing laparoscopic surgery may require conversion to open surgery in some cases.

  • After bowel resection: Patients have a mean follow-up duration of 6.8 years. The incidence of incisional hernia at 36 months is nearly identical in both open and laparoscopic surgery groups. Patients undergoing laparoscopic resection with intra-abdominal anastomosis and small transverse or trocar site extraction incisions have a lower risk of incisional hernia.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with bowel resection surgery for Crohn’s disease?
  2. How does the age at onset of disease, duration of disease, and previous surgeries impact the likelihood of developing an incisional hernia after surgery?
  3. What factors increase the risk of needing a conversion from laparoscopic to open surgery during a bowel resection for Crohn’s disease?
  4. What specific advanced laparoscopic techniques can be used to reduce or prevent the development of an incisional hernia following bowel resection?
  5. How long is the typical recovery period following bowel resection surgery for Crohn’s disease, and what can I expect during the recovery process?
  6. Are there any dietary or lifestyle changes that I should make post-surgery to help prevent complications like incisional hernias?
  7. How often should I follow up with my surgeon after the bowel resection surgery, and what signs or symptoms should I watch out for that may indicate a problem with the surgical site?
  8. Are there any specific exercises or physical therapy techniques that I can do to strengthen my abdominal muscles and reduce the risk of developing an incisional hernia after surgery?
  9. What are the long-term implications of developing an incisional hernia following bowel resection surgery for Crohn’s disease, and how can it be effectively treated if it does occur?
  10. Are there any additional resources or support groups available for patients undergoing bowel resection surgery for Crohn’s disease to help with recovery and any potential complications?

Reference

Authors: Heimann TM, Swaminathan S, Greenstein AJ, Greenstein AJ, Khaitov S, Steinhagen RM, Salky BA. Journal: Surg Endosc. 2017 Dec;31(12):5201-5208. doi: 10.1007/s00464-017-5588-8. Epub 2017 May 18. PMID: 28523361