Targeting the Mesentery with Surgery

Abstract

Traditionally, other than its role in lymphadenectomy for neoplastic disease, the mesentery has not been the target of surgery in gastrointestinal diseases. However, increasingly the mesentery has been implicated in the pathophysiology of Crohn’s disease and possibly ulcerative colitis. In this chapter, we review the role of the mesentery in inflammation as well as the traditional surgical approaches to both malignant and benign diseases including colorectal cancer and inflammatory bowel disease. We will then review the progressive surgical approaches targeting the mesentery as a source of inflammation, including peri-pouch fat, extended mesenteric excision, and the Kono-S anastomosis. Surgical targeting of the mesentery in colorectal cancer is the current standard of care globally. However, for ulcerative colitis, additional studies are needed to assess whether mesenteric excision in the setting of ileoanal pouch construction is beneficial. Given the low rate of surgical recurrence of diverticular disease, such studies are unlikely to be undertaken. In Crohn’s disease, forthcoming studies will reveal whether novel techniques and procedures lead to reductions in postoperative disease recurrence.