Skip to main content

Advertisement

SpringerLink
Log in

Risk factors and predictors of 30-day complications and conversion to open surgery after repeat ileocolic resection of Crohn’s disease

  • Original Article
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Repeat ileocolic resection of Crohn’s disease (CD) is a challenging procedure that can be followed by a high rate of complications. The present study aimed to identify the factors associated with complications and conversion to open surgery in patients undergoing repeat ileocolic resection for CD.

Methods

This was a retrospective review of an IRB-approved prospective database of CD patients who underwent elective repeat ileocolic resection between 2011 and 2021. Univariate and multivariate analyses were performed to determine the predictive factors of postoperative complications and conversion to open surgery.

Results

The present study included 65 patients (47.7% male) with a mean age of 52.5 years. 43.1% of patients developed short-term complications, most of which were of Clavien–Dindo class I–II. Longer operative time was found to be an independent predictor of complications (OR 1.016, p = 0.014). The preoperative use of biological therapy was an independent protective factor from complications (OR 0.243, p = 0.016). The only significant risk factor of a longer operation time was higher BMI (OR 3.11, p = 0.044). Overall, 28.1% of laparoscopic procedures were converted to laparotomy. According to bivariate analysis, previous ileocolic open resection (OR 190, p < 0.0001), longer operation time (OR 1.01; p = 0.036), and takedown of incidental fistula of incidental fistula (OR 3.78, p = 0.04) were associated with higher odds of conversion to open surgery.

Conclusion

Longer operation time was significantly associated with and predictive of complications after repeat ileocolic resection of CD. Preoperative biological therapy was predictive of a lower rate of complications. Previous ileocolic resection by laparotomy, longer operation time, and takedown of fistula were associated with a higher likelihood of conversion to open surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Matsuoka K, Kobayashi T, Ueno F et al (2018) Evidence-based clinical practice guidelines for inflammatory bowel disease. J Gastroenterol 53(3):305–353. https://doi.org/10.1007/s00535-018-1439-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Rubin DT, Panaccione R, Chao J, Robinson AM (2011) A practical, evidence-based guide to the use of adalimumab in Crohn’s disease. Curr Med Res Opin 27(9):1803–1813

    Article  PubMed  Google Scholar 

  3. Kornbluth A, Sachar DB, Salomon P (1998) Crohn’s disease. In: Feldman M, Scharschmidt BF, Sleisenger MH (eds) Sleisenger & Fordtran’s gastrointestinal and liver disease: pathophysiology, diagnosis, and management, vol 2, 6th edn. WB Saunders Co, Philadelphia, pp 1708–1734

    Google Scholar 

  4. Colombo F, Frontali A, Baldi C, Cigognini M, Lamperti G, Manzo CA, Maconi G, Ardizzone S, Foschi D, Sampietro GM (2022) Repeated surgery for recurrent Crohn’s disease: does the outcome keep worsening operation after operation? A comparative study of 1224 consecutive procedures. Updates Surg 74(1):73–80. https://doi.org/10.1007/s13304-021-01187-0

    Article  PubMed  Google Scholar 

  5. Carmichael H, Peyser D, Baratta VM, Bhasin D, Dean A, Khaitov S, Greenstein AJ, Sylla P (2021) The role of laparoscopic surgery in repeat ileocolic resection for Crohn’s disease. Colorectal Dis 23(8):2075–2084. https://doi.org/10.1111/codi.15675

    Article  PubMed  Google Scholar 

  6. Celentano V (2020) Laparoscopic redo surgery in recurrent ileocolic Crohn’s disease: a standardised technique. J Minim Access Surg 16(1):90–93

    Article  PubMed  Google Scholar 

  7. Frolkis AD, Lipton DS, Fiest KM et al (2014) Cumulative incidence of second intestinal resection in Crohn’s disease: a systematic review and meta-analysis of population-based studies. Am J Gastroenterol 109(11):1739–1748. https://doi.org/10.1038/ajg.2014.297

    Article  PubMed  Google Scholar 

  8. Kalman TD, Everhov ÅH, Nordenvall C, Sachs MC, Halfvarson J, Ekbom A, Ludvigsson JF, Myrelid P, Olén O (2020) Decrease in primary but not in secondary abdominal surgery for Crohn’s disease: nationwide cohort study, 1990–2014. Br J Surg 107(11):1529–1538. https://doi.org/10.1002/bjs.11659

    Article  CAS  PubMed  Google Scholar 

  9. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae

    Article  PubMed  PubMed Central  Google Scholar 

  10. Shawki S, Bashankaev B, Denoya P, Seo C, Weiss EG, Wexner SD (2009) What is the definition of “conversion” in laparoscopic colorectal surgery? Surg Endosc 23(10):2321–2326. https://doi.org/10.1007/s00464-009-0329-2

    Article  PubMed  Google Scholar 

  11. Shigeta K, Okabayashi K, Hasegawa H, Tsuruta M, Seishima R, Kitagawa Y (2016) Meta-analysis of laparoscopic surgery for recurrent Crohn’s disease. Surg Today 46(8):970–978. https://doi.org/10.1007/s00595-015-1271-7

    Article  CAS  PubMed  Google Scholar 

  12. Heimann TM, Greenstein AJ, Lewis B, Kaufman D, Heimann DM, Aufses AH Jr (1998) Comparison of primary and reoperative surgery in patients with Crohns disease. Ann Surg 227(492):495

    Google Scholar 

  13. Cheng H, Clymer JW, Po-Han Chen B, Sadeghirad B, Ferko NC, Cameron CG, Hinoul P (2018) Prolonged operative duration is associated with complications: a systematic review and meta-analysis. J Surg Res 229:134–144. https://doi.org/10.1016/j.jss.2018.03.022

    Article  PubMed  Google Scholar 

  14. Kim JY, Khavanin N, Rambachan A et al (2015) Surgical duration and risk of venous thromboembolism. JAMA Surg 150:110–117

    Article  PubMed  Google Scholar 

  15. Hoekstra LT, Van Trigt JD, Reiniers MJ et al (2012) Vascular occlusion or not during liver resection: the continuing story. Dig Surg 29:35–42

    Article  PubMed  Google Scholar 

  16. Fogarty B, Khan K, Ashall G, Leonard A (1999) Complications of long operations: a prospective study of morbidity associated with prolonged operative time (>6 h). Br J Plast Surg 52:33–36

    Article  CAS  PubMed  Google Scholar 

  17. Ri M, Aikou S, Seto Y (2017) Obesity as a surgical risk factor. Ann Gastroenterol Surg. 2(1):13–21

    Article  PubMed  PubMed Central  Google Scholar 

  18. Miyamoto Y, Ishii T, Tashiro J et al (2014) Effects of obesity on the outcome of laparoscopic surgery for colorectal cancer. Surg Today 44:1293–1299

    Article  PubMed  Google Scholar 

  19. Ahmed Ali U, Martin ST, Rao AD, Kiran RP (2014) Impact of preoperative immunosuppressive agents on postoperative outcomes in Crohn’s disease. Dis Colon Rectum 57(5):663–674

    Article  PubMed  Google Scholar 

  20. White EC, Melmed GY, Vasiliauskas E et al (2012) Does preoperative immunosuppression influence unplanned hospital readmission after surgery in patients with Crohn’s disease? Dis Colon Rectum 55(5):563–568

    Article  PubMed  Google Scholar 

  21. Colombel JF, Loftus EV Jr, Tremaine WJ et al (2004) Early postoperative complications are not increased in patients with Crohn’s disease treated perioperatively with infliximab or immunosuppressive therapy. Am J Gastroenterol 99(5):878–883

    Article  CAS  PubMed  Google Scholar 

  22. Cohen BL, Fleshner P, Kane SV et al (2019) 415a–anti-tumor necrosis factor therapy is not associated with post-operative infection: results from prospective cohort of ulcerative colitis and Crohn’s disease patients undergoing surgery to identify risk factors for postoperative infection I (Puccini). Gastroenterology 156(6):S-80

    Article  Google Scholar 

  23. Masoomi H, Moghadamyeghaneh Z, Mills S, Carmichael JC, Pigazzi A, Stamos MJ (2015) Risk factors for conversion of laparoscopic colorectal surgery to open surgery: does conversion worsen outcome? World J Surg 39(5):1240–1247. https://doi.org/10.1007/s00268-015-2958-z

    Article  PubMed  Google Scholar 

  24. Bouquot M, Maggiori L, Hain E et al (2019) What is the outcome for patients undergoing more than two ileocolonic resections for recurrent Crohn’s disease? A comparative study of 569 consecutive procedures. Colorectal Dis 21:563–569. https://doi.org/10.1111/codi.14562

    Article  CAS  PubMed  Google Scholar 

  25. Abdalla S, Brouquet A, Maggiori L et al (2019) Postoperative morbidity after iterative ileocolonic resection for Crohn’s disease: should we be worried? A prospective multicentric cohort study of the GETAID Chirurgie. J Crohns Colitis 13:1510–1517. https://doi.org/10.1093/ECCO-JCC/JJZ091

    Article  PubMed  Google Scholar 

  26. Brouquet A, Bretagnol F, Soprani A et al (2010) A laparoscopic approach to iterative ileocolonic resection for the recurrence of Crohn’s disease. Surg Endosc 24:879–887. https://doi.org/10.1007/S00464-009-0682-1

    Article  PubMed  Google Scholar 

  27. Celentano V, Sagias F, Flashman KG, Conti J, Khan J (2019) Laparoscopic redo ileocolic resection for Crohn’s disease in patients with previous multiple laparotomies. Scand J Surg. https://doi.org/10.1177/1457496918772370

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA

    Sameh Hany Emile, Michael R. Freund, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Emanuela Silva-Alvarenga & Steven D. Wexner

  2. Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

    Sameh Hany Emile

  3. Department of General Surgery, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel

    Michael R. Freund

  4. Department of Surgery and Transplantations, Faculty of Medicine, Sheba Medical Center, Ramat Gan, Israel

    Nir Horesh

Authors
  1. Sameh Hany Emile
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael R. Freund
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nir Horesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Zoe Garoufalia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rachel Gefen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emanuela Silva-Alvarenga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Steven D. Wexner
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SE designed the study. MF and NH collected and interpreted the data. SE performed the data analysis and interpretation. SE wrote the manuscript. MF, NH, ZG, ESA, and RG critically revised the manuscript. SW reviewed the protocol and initial results of the study and critically revised the manuscript. All authors critically reviewed the manuscript and approved the final version.

Corresponding author

Correspondence to Steven D. Wexner.

Ethics declarations

Disclosure

Sameh Emile, Michael Freund, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Emanuela Silva-Alvarnega, and Steven Wexner have no relevant conflicts of interest to be disclosed.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Emile, S.H., Freund, M.R., Horesh, N. et al. Risk factors and predictors of 30-day complications and conversion to open surgery after repeat ileocolic resection of Crohn’s disease. Surg Endosc 37, 941–949 (2023). https://doi.org/10.1007/s00464-022-09557-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-022-09557-4

Keywords

Search

Navigation