Mesenteric preservation vs extended mesenteric excision in Crohn's disease: A systematic review and meta-analysis

Background There remains ongoing debate and lack of consensus regarding the benefit of extended mesenteric excision (EME) compared to limited mesenteric excision (LME) in the surgical management of Crohn's disease (CD). This study aimed to synthesise the most recent evidence through an up-to-date meta-analysis comparing clinical outcomes following EME versus LME. Methods This study was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, with prospective registration on PROSPERO (CRD420251020438). PubMed, Cochrane and Scopus were searched for studies published to April 2025. The primary outcome was surgical recurrence, defined as need for repeat surgery for CD. Secondary outcomes included endoscopic recurrence, postoperative complications, length of stay and operative duration. Meta-analysis was performed using RevMan 5.4. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Risk of bias was assessed using ROBINS-I and RoB2 criteria. Results Six studies (four non-randomized and two randomized), comprising 4469 patients, met inclusion criteria. EME was significantly associated with reduced surgical recurrence compared to LME (OR = 0.31; 95% CI [0.11–0.87]; p = 0.03). There was no difference in endoscopic recurrence between groups (OR 0.77; 95% CI 0.46–1.27; p = 0.30). There were no significant differences in rates of superficial surgical site infection, intra-abdominal collections, anastomotic leaks, operative duration or length of stay. Conclusion Our findings demonstrate that EME is associated with a significant reduction in surgical recurrence in CD compared to LME, without any increase in post-operative complications, operative time, or length of hospital stay.