Aspects Towards the Anastomotic Healing in Crohn’s Disease: Clinical Approach and Current Gaps in Research

Abstract

Anastomotic leakage is a major complication in gastrointestinal and colorectal surgery and its occurrence increases morbidity and mortality. Its incidence is even higher in Crohn’s disease surgeries. Several authors have identified factors involved in the pathophysiology of anastomotic leak in the literature, aiming to reduce its occurrence and, therefore, improve its surgical treatment. Surgical technique is the most discussed topic in studies on guiding the performance of side-to-side stapled anastomosis. Preoperative nutritional therapy also has been shown to reduce the risk of anastomotic leakage. Other factors remain controversial – immunomodulator use and biologic therapy, antibiotics, and gut microbiota – with studies showing a reduction in the risk of complication while other studies show no correlation. Although mesenteric adipose tissue has been related to disease recurrence, there is no evidence in the literature that it is related to a higher risk of anastomotic leakage. Further exploration on this topic is necessary, including prospective research, to support the development of techniques to prevent anastomotic leakage, in this way benefiting the inflammatory bowel disease patients who have to undergo a surgical procedure.

Changes in HLA-B27 Transgenic Rat Fecal Microbiota Following Tofacitinib Treatment and Ileocecal Resection Surgery: Implications for Crohn’s Disease Management

“…Moreover, given the high frequency of necessary surgical resections of macroscopic ileocecal or colonic lesions (30% to 50% throughout the patient's lifetime), predominant subclinical (endoscopic) postoperative recurrences at anastomotic sites (reaching up to 70% rate) and further clinical extents also have to be taken into account to improve the efficiency of either prophylactic or therapeutic approaches. The physiopathology-sustaining postoperative recurrences of Crohn's disease remain unknown, although interactions between the enteric and systemic immune system and the gut microbiota at mucosal sites are highly suggested [8,9]. Additionally, it is also well established that overall intestinal surgeries, including ileocecal resection and colorectal surgery, can strongly modify the gut microbiome structure and affect its functionality [10][11][12][13][14].…”

Saccharomyces cerevisiae prevents postoperative recurrence of Crohn's disease modeled by ileocecal resection in HLA-B27 transgenic rats

“…The physiopathology sustaining POR of CD remains partially unknown. Abnormal interactions between the mucosal/mesenteric immune system and the intestinal microbiota favored by surgical techniques and environmental factors are pivotal hallmarks in POR dynamics[ 5 ]. Recently, ileal transcriptome analyses of CD patients found a gene signature of POR characterized by an upregulation of the interleukin (IL)-23 and IL-17 pathways together with abnormal JAK/STAT activation[ 6 ].…”

Crohn’s Disease as a Possible Risk Factor for Failed Healing in Ileocolic Anastomoses

“…Especially in Crohn's disease (CD), the failure of anastomotic healing may lead to a detrimental postoperative course. In these specific patients, the rates of AL vary from 3-23% [5][6][7][8]. The failure of anastomotic healing can become evident as a leakage occurring at the anastomotic site with septic complications, such as peritonitis or intra-abdominal abscesses.…”