Extended mesenteric resection reduces the rate of surgical recurrence in Crohn's disease: a systematic review and meta-analysis.

Purpose: Mesenteric resection in Crohn's disease (CD) is still controversial and under discussion. We performed a meta-analysis to assess recurrence rates and operative-related morbidity based on the extent of mesenteric resection.

Methods: A comprehensive literature research was conducted until November 2024 using PubMed (Medline), the Cochrane Central trials register, and Google Scholar databases. Studies before the biological era or with Kono-S anastomosis were excluded. Data from comparative studies with reported patient characteristics and outcome results of extended and limited mesenteric resections were extracted and subsequently entered into a pairwise meta-analysis model. Odds ratios (ORs) for dichotomous variables and standardized mean differences (SMDs) for continuous outcomes with 95% confidence intervals (CIs) were calculated. The risk of bias was rated according to ROBINS-I and Rob2 criteria, respectively.

Results: Four non-randomized studies and one randomized trial with a total of 4358 patients (extended mesenteric resection: n = 993 versus mesenteric preservation: n = 3365) met eligibility criteria and were included. Extended mesenteric resection was significantly associated with reduced surgical recurrence rates compared to mesenteric preservation (OR = 4.94; 95% CI [2.22-10.97]; p < 0.001, I = 0%). In terms of endoscopic recurrence, postoperative morbidity, and hospital stay, no significant differences between both groups were noted within the short follow-up period.

Conclusion: Extended mesenteric resection demonstrated a lower surgical recurrence rate in Crohn's disease, while morbidity rates were comparable to the mesenteric sparing approach, whether extended mesenteric excision should be recommended requires further high-quality randomized trials with long-term follow-up data.