Risks of Intestinal Anastomoses in Crohnʼs Disease

Abstract

Six hundred fifty-eight intestinal anastomoses in 429 operations for Crohn's disease were studied prospectively during an 8-year period to detect variables connected with perioperative morbidity. Postoperative complications occurred in 9.7% of the patients, 4% had to be reoperated on, and the overall mortality rate was 0.5%. In multivariate analysis by stepwise logistic regression, the only variable significantly (p = 0.03) associated with overall rate of complications was long-term corticosteroid therapy. Serious complications were more common in cases of intra-abdominal abscesses (p = 0.01) and preoperative steroid medication (p = 0.03). The combination of both of these risk factors increased the rate of reoperations from 0.6% (no steroids, no abscess) to 16% (steroids and abscess). No significant association with postoperative complications could be found for age, sex, duration of disease, previous operations, nutritional status, emergency surgery, extent of disease, type, number, and localization of anastomoses, presence of proximal ileo-/colostomy, or histologically inflamed margins of resection.

Acute phase proteins in drain fluid: a new screening tool for colorectal anastomotic leakage? The APPEAL study: analysis of parameters predictive for evident anastomotic leakage

“…[24][25][26] This study shows the use of corticosteroids to be correlated to CAL. It confirms the results published by Slieker et al, who used the same database.…”

Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

“…Poor nutritional state and low serum albumin certainly increase post-operative morbidity and the risk of a twostage procedure. 7,19,20 Pre-operative nutritional therapies can improve nutritional parameters and wound healing even before nutritional parameters show any change. 21,22 Recent calorie intake may be more important than nutritional status.…”

“…5 Patients who had abdominal surgery for penetrating CD still experience a high rate of post-operative complications. 6,7 A two-stage procedure including a temporary diverting stoma is often required in up to 39-51% of patients. 8,9 Several risk factors have been associated with a poor outcome of surgery for penetrating CD such as the presence of an abscess at the time of surgery, the use of chronic corticosteroid medication and an impaired nutritional status.…”

Surgical Management of Primary Crohn’s Disease

“…It requires resection of the perforated segment and performing a stoma [16] that we prefer to transformation of the perforation in stoma which is difficult to perform because of the abondance of sclerolipomatosis.…”

“…External derivations (ileostomy, colostomy) are indicated to protect an anastomosis or more frequently to derive the fecal stream in case of major rectal or perineal lesions [16]. The internal derivations (i.e., gastro-entero-anastomosis) are indicated in case of lesion localized in the duodenum.…”