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Effect of anastomotic configuration on Crohn’s disease recurrence after primary ileocolic resection: a comparative monocentric study of end-to-end versus side-to-side anastomosis

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Abstract

There is ongoing debate whether the type of anastomosis following intestinal resection for Crohn’s disease (CD) can impact on complications and postoperative recurrence. The aim of the present study is to describe the outcomes of side-to-side (S–S) vs end-to-end (E–E) anastomosis after ileocecal resection for CD. A retrospective comparative study was conducted in consecutive CD patients who underwent primary ileocecal resection between 2005 and 2013. All patients underwent colonoscopy 6 months postoperatively to assess endoscopic recurrence, defined as Rutgeerts’ score (RS) ≥ i2. Surgical recurrence implied reoperation due to CD activity at the anastomotic site. Modified surgical recurrence was defined as the need for reoperation or balloon-dilation. Perioperative factors related to recurrence were evaluated. Of the 127 patients included, 51 (40.2%) received an E–E anastomosis. Median follow-up was longer in the E–E group (8.62 vs 13.68 years). Apart from the microscopic resection margins, patient, disease and surgical characteristics were similar between both groups. Anastomotic complications were comparable (S–S 5.3% vs E–E 5.8%, p = 1.00)0. Postoperatively, biologicals were used in 55.3% and 62.7% (p = 0.47) in S–S and E–E patients, respectively. Endoscopic recurrence did not differ between S–S and E–E patients (78.9 vs 72.9%, p = 0.37), with no significant difference in RS values between both groups (p = 0.87). Throughout follow-up, a higher surgical (p = 0.04) and modified surgical recurrence (p = 0.002) rate was observed in the E–E anastomosis group. Type of anastomosis was an independent risk factor for modified surgical recurrence. The type of anastomosis did not influence endoscopic recurrence and immediate postoperative disease complications. However, the wide diameter and the morphologic characteristic of the stapled S–S anastomosis resulted in a significant reduced risk for surgical and endoscopic reintervention on the long term.

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Acknowledgements

Bram Verstockt is supported by a Clinical Research Fund (KOOR) from the University Hospitals Leuven, Belgium and the Research Council at KU Leuven, Belgium. João Sabino is a senior clinical investigator of the Research Foundation Flanders (FWO).

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Authors and Affiliations

  1. Department of Abdominal Surgery, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Gabriele Bislenghi, Peter-Jan Vancoillie, Albert Wolthuis & André D’Hoore

  2. Interuniversity Center for Biostatistics and Statistical Bioinformatics, University of Leuven and Univerisity of Hasselt, Leuven, Hasselt, Belgium

    Steffen Fieuws

  3. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium

    Bram Verstockt & Joao Sabino

  4. Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium

    Bram Verstockt & Joao Sabino

Authors
  1. Gabriele Bislenghi
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  4. Bram Verstockt
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Correspondence to Gabriele Bislenghi.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Furthermore, all the possible conflicts of interest are now disclosed: Gabriele Bislenghi: Speaker’s fee from Janssen, Galapagos. Bram Verstockt: Research support from AbbVie, Biora Therapeutics, Landos, Pfizer, Sossei Heptares and Takeda. Speaker’s fees from Abbvie, Biogen, Bristol Myers Squibb, Celltrion, Chiesi, Falk, Ferring, Galapagos, Janssen, MSD, Pfizer, R-Biopharm, Takeda, Truvion and Viatris. Consultancy fees from Abbvie, Alimentiv, Applied Strategic, Atheneum, Biora Therapeutics, Bristol Myers Squibb, Galapagos, Guidepont, Landos, Mylan, Inotrem, Ipsos, Janssen, Progenity, Sandoz, Sosei Heptares, Takeda, Tillots Pharma and Viatris. Joao Sabino: Speaker’s fees from Pfizer, Abbvie, Ferring, Falk, Takeda, Janssen, and Fresenius; consultancy fees from Janssen, Ferring, Fresenius, Abbvie, Galapagos, Celltrion, Pharmacosmos, and Pharmanovia; and research support from Galapagos and Viatris. Albert Wolthuis: No conflicts of interest to be declared. André D’Hoore: No conflicts of interest to be declared. This research study was conducted retrospectively from data obtained for clinical purposes with all the procedures being performed were part of the routine care. Approval was obtained from the ethics committee of University of Leuven. All included patients had given written consent to participate in the Institutional Review Board approved IBD Biobank CCARE (B322201213950/S53684)–Leuven.

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The study was approved by the local ethics committee of University Hospitals Leuven and performed in accordance to the ethical standard as reported in the 1964 declaration of Helsinki.

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All procedure performed in studies involving human participants were in accordance with the ethical standard of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable standards.

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Bislenghi, G., Vancoillie, PJ., Fieuws, S. et al. Effect of anastomotic configuration on Crohn’s disease recurrence after primary ileocolic resection: a comparative monocentric study of end-to-end versus side-to-side anastomosis. Updates Surg 75, 1607–1615 (2023). https://doi.org/10.1007/s13304-023-01561-0

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