Mesenteric excision and postoperative small bowel obstruction

What is known

• A 2025 SR/MA of 4 studies (632 patients) comparing EME vs LME in primary ileocolic resection found no significant difference in endoscopic recurrence; secondary outcomes were leak, operative time, conversion, severe complications, and length of stay, not small bowel obstruction. ¹
• The evidence base includes the SPICY and MESOCOLIC RCTs, which showed no difference in mesentery-directed resection for preventing postoperative (endoscopic) recurrence. ^1–3
• Multiple 2025 systematic reviews frame the extent-of-mesenteric-excision question around recurrence and perioperative complications rather than bowel obstruction. ^3,4

What is unknown / caveats

• Postoperative small bowel obstruction is not reported as a discrete endpoint in the retrieved excerpts
• Primary endpoint across the trials/MAs is endoscopic recurrence, not obstruction
• Included trials are recent and small (632 patients pooled across 4 studies)
• Whether EME alters small bowel obstruction risk cannot be answered from the retrieved evidence, which does not tabulate this outcome.

References

1. [No authors listed]. Effect of extensive mesenteric excision on primary ileocolic resection outcomes in Crohn's disease patients: a systematic review with meta-analysis. Int J Colorectal Dis. 2025;40(1):243. PMID: 41329358.

2. Mañosa M, Fernández-Clotet A, Nos P, Martín-Arranz MD, Manceñido N, Carbajo A, Hinojosa E, Hernández-Camba A, Muñoz-Pérez R, Boscá-Watts M, Calvo M, Sierra-Ausín M, Sánchez-Rodríguez E, Barreiro-de Acosta M, Núñez-Alonso A, Zabana Y, Márquez L, Gisbert JP, Guardiola J, Sáinz E, Delgado-Guillena P, Busquets D, van Domselaar M, Girona E, Lorente R, Casas-Deza D, Huguet JM, Maestro S, Cabello MJ, Castro J, Iborra M, Cañete F, Calafat M, Domènech E, ENEIDA registry by GETECCU. Ustekinumab and vedolizumab for the prevention of postoperative recurrence of Crohn's disease: Results from the ENEIDA registry. Dig Liver Dis. 2023;55(1):46-52. PMID: 35948459.

3. Maatouk M, Khalifa MB, Essid N, Mabrouk A, Nouira M, Boudokhane M, Moussa MB. Mesenteric inclusion in Crohn's disease surgery: Promising breakthrough or tempest in a teapot? An updated meta-analysis. Surg Open Sci. 2025;28:89-97. PMID: 41403856.

4. Mostafa OES, Zaman S, Malik M, Kumar P, Kumar L, Akingboye A, Sarma D, Peravali R. Clinical outcomes of conventional versus extended mesenteric resection in limited ileo-colonic Crohn's disease: a systematic review and meta-analysis. Int J Colorectal Dis. 2025;40(1):144. PMID: 40528089.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.