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Surgical management of complex ileocolonic Crohn’s disease: a survey of IBD colorectal surgeons to assess variability in operative strategy Garofalo, E Selvaggi, F Spinelli, A Flashman, K Frasson, M Espin-Basany, Eloy Pellino, Gianluca Institut Català de la Salut [Garofalo E] Department of General Surgery, Sant’Andrea Hospital, La Sapienza University, Rome, Italy. [Selvaggi F, Pellino G] Department of Advanced Medical and Surgical Sciences, Universitádella Campania “Luigi Vanvitelli”, Naples, Italy. [Spinelli A] Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Milan, Italy. IRCCS Humanitas Research Hospital, 20089 Rozzano, Milan, Italy. [Flashman K] Colorectal Unit, Queen Alexandra Hospital – Portsmouth Hospitals NHS Trust, Portsmouth, UK. [Frasson M] Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain. [Espin E] Servei de Cirurgia General, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain Vall d'Hebron Barcelona Hospital Campus Crohn, Malaltia de - Cirurgia Qüestionaris Terapèutica - Presa de decisions DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Gastroenteritis::Inflammatory Bowel Diseases::Crohn Disease Other subheadings::Other subheadings::Other subheadings::/surgery ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Investigative Techniques::Epidemiologic Methods::Data Collection::Surveys and Questionnaires ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::gastroenteritis::enfermedad inflamatoria intestinal::enfermedad de Crohn Otros calificadores::Otros calificadores::Otros calificadores::/cirugía TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::técnicas de investigación::métodos epidemiológicos::recopilación de datos::encuestas y cuestionarios Cirurgia colorectal; Malaltia de Crohn; Resecció ileocecal Cirugía colorrectal; Enfermedad de Crohn; Resección ileocecal Colorectal surgery; Crohn’s disease; Ileocaecal resection Introduction To explore the reported variability in the surgical management of ileocolonic Crohn’ s disease and identify areas of standard practice, we present this study which aims to assess how different colorectal surgeons with a subspecialty interest in inflammatory bowel disease (IBD) surgery may act in different clinical scenarios of ileocolonic Crohn’s disease. Methods Anonymous videos demonstrating the small bowel walkthrough and anonymised patients’ clinical data, imaging and pathological findings were distributed to the surgeons using an electronic tool. Surgeons answered on operative strategy, bowel resections, management of small bowel mesentery, type of anastomosis and use of stomas. Results Eight small bowel walkthrough videos were registered and 12 assessors completed the survey with a questionnaire completion rate of 87.5%. There was 87.7% agreement in the need to perform an ileocolonic resection. However, the agreement for the need to perform associated surgical procedures such as strictureplasties or further bowel resections was only 57.4%. When an anastomosis was fashioned, the side to side configuration was the most commonly used. The preferred management of the mesentery was dissection close to the bowel. Conclusions The decision on the main procedure to be performed had a high agreement amongst the different assessors, but the treatment of multifocal disease was highly controversial, with low agreement on the need for associated procedures to treat internal fistulae and the use of strictureplasties. At the same time, there was significant heterogeneity in the decision on when to anastomose and when to fashion an ileostomy. 2022-01-25T12:08:31Z 2022-01-25T12:08:31Z 2021-08 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Garofalo E, Selvaggi F, Spinelli A, Pellino G, Flashman K, Frasson M, et al. Surgical management of complex ileocolonic Crohn’s disease: a survey of IBD colorectal surgeons to assess variability in operative strategy. Int J Colorectal Dis. 2021 Aug;36:1811–1815. 1432-1262 https://hdl.handle.net/11351/6892 10.1007/s00384-021-03892-z 33629119 000621242500001 http://hdl.handle.net/11351/6892 eng International Journal of Colorectal Disease;36 https://doi.org/10.1007/s00384-021-03892-z Attribution 4.0 International http://creativecommons.org/licenses/by/4.0/ info:eu-repo/semantics/openAccess application/pdf application/pdf application/pdf application/pdf Springer Scientia