A SURGICAL approach pioneered in Limerick could have a global impact on the treatment of Crohn’s disease and save patients from having to undergo multiple surgeries.
The new approach to treatment has been made possible by the reclassification of part of the stomach as a new organ and research on the results of removing it by University Hospital Limerick (UHL) Professor of Surgery John Calvin Coffey and his research team.
Crohn’s disease is incurable, with high rates of recurrence, even after surgery. It is a condition for which at least 80 per cent of patients will require surgery to treat at some point. To add to this, around 40 per cent of those will require repeat surgery.
However, the new approach pioneered at University of Limerick and UHL dramatically reduces the possibility that follow-up surgery will be needed to as few as approximately 4 per cent of patients.
The new surgical approach requires removal of the mesentery, a fold of membrane that attaches the intestine to the wall around the stomach area and holds it in place.
The mesentery was reclassified as a new organ following discoveries by Professor Coffey’s team and collaborators in 2016.
An international trial, just published in Gastroenterology, has validated the approach used by Professor Coffey and colleagues which could be very significant for treating Crohn’s disease.
“Crohn’s disease has a terrible impact on patient’s lives,” said Professor Coffey, who is Foundation Chair of Surgery at UL’s School of Medicine and Consultant General and Colorectal Surgeon at UHL.
“These patients are generally young. They are most affected by the disease just at that time when they are embarking on new careers, buying houses, getting married, and starting families. As a result of the disease, they are committed to an awful reality during this very important time.
“These patients often require repeated admissions to hospital and sometimes they are very ill. Ultimately, they then must undergo surgery. This has remained the case despite almost a century of investigating potential medical or pharmaceutical means of stopping the disease developing or advancing.
“Prior to this technique, the convention among surgeons was to leave the mesentery in part because removing it is technically challenging. The safe removal of the mesentery in Crohn’s disease was helped by the advances made in our understanding of the mesentery at UHL and UL,” explained Professor Coffey.
The results of the trial, led by international collaborators including Dr Yi Li of Nanjing University in China, is an independent, high-level validation of the surgical approach first developed in Limerick.
The randomised control trial found that patients who had conventional surgery tended to suffer high rates of relapse, but that patients who had surgery performed using the new approach, had lower relapse rates – from around 46 per cent down to just 23.
“The results mean the approach developed in Limerick could become standard practice in the management of patients with Crohn’s disease,” said Professor Coffey.
“This study is further support for the fact that surgery in which the mesentery is removed reduces the need for readmissions, repeated medications, and the requirement for re-operation in patients with Crohn’s disease. So this is very positive news indeed for patients with Crohn’s disease and for their families,” Professor Coffey added.
