{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,5,4]],"date-time":"2024-05-04T15:13:00Z","timestamp":1714835580136},"reference-count":27,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Z Gastroenterol"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Einleitung Die Behandlung des M. Crohn \u2013 vor allem die medikament\u00f6se \u2013 erlebte in den letzten 20\u201330 Jahren einen starken Wandel. Die vorliegende Beobachtungsstudie fasst alle Darmresektionen wegen M. Crohn zusammen, die in den letzten 3 Dekaden an 2 gro\u00dfen spezialisierten Zentren durchgef\u00fchrt wurden. Die perioperativen Trends und Entwicklungen sollten identifiziert werden.<\/jats:p><jats:p>\n          Methoden Eingeschlossen wurden alle Darmresektionen bei M. Crohn. Ausschlusskriterien waren: Resektionen bei Malignit\u00e4t, abdominoperineale Rektumexstirpationen wegen Crohn-Analfisteln, ausschlie\u00dfliche Stomaanlagen und -r\u00fcckverlagerungen und Resektionen, die einen anderen Grund als M. Crohn hatten. Die Daten wurden von 1992 bis 2004 retrospektiv und danach prospektiv gesammelt. Ausgewertet wurden 6 Zeitr\u00e4ume: 1992\u20131995, 1996\u20132000, 2001\u20132005, 2006\u20132010, 2011\u20132015 und 2016\u20132020. <\/jats:p><jats:p>\n          Ergebnisse Es wurden 811 Darmresektionen ausgewertet. Zwischen 2000 und 2015 konnten gleich mehrere sehr starke Trends beobachtet werden: erh\u00f6hte pr\u00e4operative Einnahme von Immunmodulatoren und Biologika, sinkende pr\u00e4operative Steroideinnahme, Verzicht auf pr\u00e4operative Darmvorbereitung, erh\u00f6hter Anteil an voroperierten Patienten und Patienten, die sich mit penetrierendem Befallsmuster vorstellten, Einf\u00fchrung neuer Operationstechniken (Laparoskopie, Stapleranastomosen) und signifikante Erh\u00f6hung der postoperativen Morbidit\u00e4t und Stomachirurgie. In den letzten 5 Jahren seit 2016 zeigten sich folgenden Entwicklungen: signifikant weniger Operationen unter Steroideinnahme oder Immunmodulatoren, signifikant mehr Operationen unter Biologika, Wiedereinf\u00fchrung der pr\u00e4operativer Darmvorbereitung, starke Reduktion der Morbidit\u00e4t und Stomaanlage, h\u00f6heres Alter der Patienten, weniger aktive Raucher, weniger Operationen wegen penetrierenden Befallsmusters, sehr starker Anstieg laparoskopischer Operationen. <\/jats:p><jats:p>\n          Schlussfolgerung Vor allem in den letzten 5 Jahren scheint die Crohn-Chirurgie wesentlich sicherer und weniger invasiv zu werden. Die Daten k\u00f6nnen jedoch nicht auf gr\u00f6\u00dfere Populationen \u00fcbertragen werden. <\/jats:p>","DOI":"10.1055\/a-1482-9147","type":"journal-article","created":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T22:46:43Z","timestamp":1624488403000},"page":"927-936","source":"Crossref","is-referenced-by-count":1,"title":["Drei Dekaden Darmresektionen bei Patienten mit M. Crohn"],"prefix":"10.1055","volume":"60","author":[{"given":"Igors","family":"Iesalnieks","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral-, Endokrine und Minimal-invasive Chirurgie, Klinik M\u00fcnchen Bogenhausen, M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayman","family":"Agha","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral-, Endokrine und Minimal-invasive Chirurgie, Klinik M\u00fcnchen Bogenhausen, M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank","family":"Dederichs","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin, Gastroenterologie, Hepatologie und Diabetologie, Kath. Klinikum Essen, Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans J\u00fcrgen","family":"Schlitt","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universit\u00e4tsklinikum Regensburg, Regensburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2021,6,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1007\/s00268-018-4844-y","article-title":"Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: 2018","volume":"43","author":"UO Gustafsson","year":"2019","journal-title":"World J Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1136\/gut.2005.082909","article-title":"The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications","volume":"55","author":"J Satsangi","year":"2006","journal-title":"Gut"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/BF02234814","article-title":"Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn\u2019s disease","volume":"44","author":"M Mu\u00f1oz-Ju\u00e1rez","year":"2001","journal-title":"Dis Colon Rectum"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/SLA.0000000000001416","article-title":"Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery","volume":"262","author":"RP Kiran","year":"2015","journal-title":"Ann Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1034","DOI":"10.1097\/SLA.0000000000001125","article-title":"Oral Antibiotic Bowel Preparation Significantly Reduces Surgical Site Infection Rates and Readmission Rates in Elective Colorectal Surgery","volume":"261","author":"MS Morris","year":"2015","journal-title":"Ann Surg"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1097\/SLA.0000000000001041","article-title":"Combined Mechanical and Oral Antibiotic Bowel Preparation Reduces Incisional Surgical Site Infection and Anastomotic Leak Rates After Elective Colorectal Resection: An Analysis of Colectomy-Targeted ACS NSQIP","volume":"262","author":"JE Scarborough","year":"2015","journal-title":"Ann Surg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/apt.13847","article-title":"Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn\u2019s disease and ulcerative colitis","volume":"45","author":"EJ Mao","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"2098","DOI":"10.1097\/MIB.0b013e31829936c2","article-title":"Infliximab reduces hospitalizations and surgery interventions in patients with inflammatory bowel disease: a systematic review and meta-analysis","volume":"19","author":"J Costa","year":"2013","journal-title":"Inflamm Bowel Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1136\/gutjnl-2019-318440","article-title":"Introduction of anti-TNF therapy has not yielded expected declines in hospitalisation and intestinal resection rates in inflammatory bowel diseases: a population-based interrupted time series study","volume":"69","author":"SK Murthy","year":"2020","journal-title":"Gut"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"876","DOI":"10.1056\/NEJMoa030815","article-title":"Infliximab maintenance therapy for fistulizing crohn\u2019s disease","volume":"350","author":"BE Sands","year":"2004","journal-title":"N Engl J Med Overseas Ed"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1097\/SLA.0b013e3181e61df5","article-title":"Trends in surgery for Crohn\u2019s disease in the era of infliximab","volume":"252","author":"DW Jones","year":"2010","journal-title":"Ann Surg"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1093\/ecco-jcc\/jjz187","article-title":"ECCO Guidelines on Therapeutics in Crohn\u2019s Disease: Surgical Treatment","volume":"14","author":"M Adamina","year":"2020","journal-title":"J Crohns Colitis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1055\/s-0034-1385199","article-title":"German Society of Gastroenterology. 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