Anastomosis configuration and technique following ileocaecal resection for Crohn’s disease: a multicentre study

Abstract

A limited ileocaecal resection is the most frequently performed procedure for ileocaecal CD and different anastomotic configurations and techniques have been described. This manuscript audited the different anastomotic techniques used in a national study and evaluated their influence on postoperative outcomes following ileocaecal resection for primary CD. This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing elective ileocaecal resection for primary CD from June 2018 May 2019. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes. 427 patients were included. The side to side anastomosis was the chosen configuration in 380 patients (89%). The stapled anastomotic (n = 286; 67%), techniques were preferred to hand-sewn (n = 141; 33%). Postoperative morbidity was 20.3% and anastomotic leak 3.7%. Anastomotic leak was independent of the type of anastomosis performed, while was associated with an ASA grade ≥ 3, presence of perianal disease and ileocolonic localization of disease. Four predictors of LOS were identified after multivariate analysis. The laparoscopic approach was the only associated with a reduced LOS (p = 0.017), while age, ASA grade ≥ 3 or administration of preoperative TPN were associated with increased LOS. The side to side was the most commonly used anastomotic configuration for ileocolic reconstruction following primary CD resection. There was no difference in postoperative morbidity according to anastomotic technique and configuration. Anastomotic leak was associated with ASA grade ≥ 3, a penetrating phenotype of disease and ileo-colonic distribution of CD.

Surgical management of complex ileocolonic Crohn’s disease: a survey of IBD colorectal surgeons to assess variability in operative strategy

“…We must acknowledge this reported variation in preferred surgical approaches and outcomes [10] which could reflect lack of standardisation. The results of our study strengthen the role of video-based education and tele-mentoring to overcome the reported limited surgical trainees' exposure to these complex procedures [11]. Surgeons could share video recordings of intraoperative findings in dedicated teaching sessions of multi-institutional meetings, with the aim to enhance surgical training in IBD and facilitate standardisation of surgical techniques.…”

Surgical Strategies to Reduce Postoperative Recurrence of Crohn's Disease After Ileocolic Resection

“…The bulk of the literature to date regarding anastomotic techniques pertains to studies of side to side anastomosis (SSA) compared to end to end anastomosis (EEA). The literature regarding these two techniques needs to be interpreted with caution as many of the studies are retrospective in nature and include a mix of both stapled and handsewn anastomoses (11,(56)(57)(58)(59)(60)(61)(62). A meta-analysis from He et al published in 2014, that included 821 patients from eight studies compared handsewn end to end anastomosis (HEEA) (n = 424) and stapled side to side anastomosis (SSSA) (n = 396) (63).…”

Has the Removing of the Mesentery during Ileo-Colic Resection an Impact on Post-Operative Complications and Recurrence in Crohn’s Disease? Results from the Resection of the Mesentery Study (Remedy)

“…In two meta-analyses, one based on eight comparative studies in CD patients, and one based on seven randomized controlled trials in colorectal surgery from the Cochrane Database of Systematic Reviews, functional end-to-end anastomosis were reported with a lower leakage and overall postoperative complications rate than hand-sewn end-to-end (but not side-to-side) anastomosis. Manual or stapled end-to-end, end-to-side, and side-to-side with double blind stumps are associated with a worse long-term recurrence rate and higher postoperative complication rate [ 36 , 37 , 38 , 39 , 40 ]. There is recent evidence that anastomotic configuration probably plays a pivotal role in CD recurrence.…”