Effect of extensive mesenteric excision on primary ileocolic resection outcomes in Crohn’s disease patients: a systematic review with meta-analysis

Purpose: The role of mesenteric excision in Crohn’s Disease (CD) remains uncertain. We aimed to evaluate the impact of extended vs. limited mesenteric excisions on intra- and postoperative outcomes in patients undergoing primary ileocolic resection for CD. Methods: A systematic search was conducted in PubMed, EMBASE, Web of Science, ClinicalTrials.gov, and ISRCTN up to February 2025. Randomized controlled trials (RCTs), non-RCTs, and retrospective studies comparing extended and limited mesenteric excision in primary ileocolic resections for CD were included. The primary outcome was endoscopic CD recurrence (Rutgeerts score ≥ i2). Secondary outcomes included severe endoscopic recurrence (≥ i2b or ≥ i3), surgical recurrence, anastomotic leaks, operative time, conversion to open surgery, severe postoperative complications, and length of hospital stay. Results: Over the 2588 records initially screened, 4 studies were included, involving a total of 632 patients. Pooled analysis showed no significant difference in endoscopic recurrence rates between extended and limited resections (48.2% vs. 54.1%; RR: 0.91; 95% CI: 0.70–1.18; p = 0.46; I² = 57%). Additionally, there were no significant differences in the risk of anastomotic leak (3.8% vs. 2.6%; RR: 1.35; 95% CI: 0.14–12.88; p = 0.80; I² = 52%) or any other analyzed outcomes. Conclusion: Extended mesenteric excision does not appear to significantly reduce endoscopic recurrence compared with limited excision in primary ileocolic resections for CD. Until further high-quality evidence is available, surgical teams should adhere to their established practice and refrain from implementing extended resections outside well-designed prospective studies. Registration: PROSPERO (CRD42025644791).