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.
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References
Pellino G, Keller DS, Sampietro GM, Angriman I, Carvello M, Celentano V, Colombo F, Di Candido F, Laureti S, Luglio G, Poggioli G, Rottoli M, Scaringi S, Sciaudone G, Sica G, Sofo L, Leone S, Danese S, Spinelli A, Delaini G, Selvaggi F, Italian Society of Colorectal Surgery SICCR (2020) Inflammatory bowel disease position statement of the Italian society of colorectal surgery (SICCR): Crohn’s disease. Tech Coloproctol. https://doi.org/10.1007/s10151-020-02183-z ([Epub ahead of print] Review)
Feng JS, Li JY, Yang Z, Chen XY, Mo JJ, Li SH (2018) Stapled side-to-side anastomosis might be benefit in intestinal resection for Crohn’s disease: a systematic review and network meta-analysis. Med (Baltim) 97(15):e0315. https://doi.org/10.1097/MD.0000000000010315
Bemelman WA, Warusavitarne J, Sampietro GM, Serclova Z, Zmora O, Luglio G, de van BuckOverstraeten A, Burke JP, Buskens CJ, Colombo F, Dias JA, Eliakim R, Elosua T, Gecim IE, Kolacek S, Kierkus J, Kolho KL, Lefevre JH, Millan M, Panis Y, Pinkney T, Russell RK, Shwaartz C, Vaizey C, Yassin N, D’Hoore A (2018) ECCO-ESCP consensus on surgery for Crohn’s Disease. J Crohns Colitis 12(1):1–16. https://doi.org/10.1093/ecco-jcc/jjx061
Ghoneima AS, Flashman K, Dawe V, Baldwin E, Celentano V (2019) High risk of septic complications following surgery for Crohn’s disease in patients with preoperative anaemia, hypoalbuminemia and high CRP. Int J Colorectal Dis 34(12):2185–2188
Rosenfeld G, Qian H, Bressler B (2013) The risks of post-operative complications following pre-operative infliximab therapy for Crohn’s disease in patients undergoing abdominal surgery: a systematic review and meta-analysis. J Crohns Colitis 7(11):868–877
Uchino M, Ikeuchi H, Bando T et al (2012) Risk factors for short bowel syndrome in patients with Crohn’s disease. Surg Today 42(5):447–452
Celentano V, O’Leary DP, Caiazzo A, Flashman KG, Sagias F, Conti J, Senapati A, Khan J (2019) Longer small bowel segments are resected in emergency surgery for ileocaecal Crohn’s disease with a higher ileostomy and complication rate. Tech Coloproctol 23(11):1085–1091
SICCR current status of Crohn’s disease surgery collaborative (2020) National variations in perioperative assessment and surgical management of Crohn’s disease: a multicentre study. Colorectal Dis. https://doi.org/10.1111/codi.15334 (Online ahead of print)
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2008) The strengthening the reporting of observational studies in epidemiology (STROBE)statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349
European society of coloproctology collaborating group (2017) Risk factors for unfavourable postoperative outcome in patients with Crohn’s disease undergoing right hemicolectomy or ileocaecal resection an international audit by ESCP and S-ECCO. Colorectal Dis. https://doi.org/10.1111/codi.13889 (Epub ahead of print)
Johnston WF, Stafford C, Francone TD, Read TE, Marcello PW, Roberts PL, Ricciardi R (2017) What Is the risk of anastomotic leak after repeat intestinal resection in patients with Crohn’s disease? Dis Colon Rectum 60(12):1299–1306
Adamina M, Bonovas S, Raine T, Spinelli A, Warusavitarne J, Armuzzi A, Bachmann O, Bager P, Biancone L, Bokemeyer B, Bossuyt P, Burisch J, Collins P, Doherty G, El-Hussuna A, Ellul P, Fiorino G, Frei-Lanter C, Furfaro F, Gingert C, Gionchetti P, Gisbert JP, Gomollon F, González Lorenzo M, Gordon H, Hlavaty T, Juillerat P, Katsanos K, Kopylov U, Krustins E, Kucharzik T, Lytras T, Maaser C, Magro F, Marshall JK, Myrelid P, Pellino G, Rosa I, Sabino J, Savarino E, Stassen L, Torres J, Uzzan M, Vavricka S, Verstockt B, Zmora O (2020) ECCO guidelines on therapeutics in Crohn’s disease: surgical treatment. J Crohns Colitis 14(2):155–168. https://doi.org/10.1093/ecco-jcc/jjz187
Gajendran M, Bauer AJ, Buchholz BM, Watson AR, Koutroubakis IE, Hashash JG, Ramos-Rivers C, Shah N, Lee KK, Cruz RJ, Regueiro M, Zuckerbraun B, Schwartz M, Swoger J, Barrie A, Harrison J, Hartman DJ, Salgado J, Rivers WM, Click B, Anderson AM, Umapathy C, Babichenko D, Dunn MA, Binion DG (2018) Ileocecal anastomosis type significantly influences long-term functional status, quality of life, and healthcare utilization in postoperative Crohn’s disease patients independent of inflammation recurrence. Am J Gastroenterol 113(4):576–583. https://doi.org/10.1038/ajg.2018.13 (Epub 2018 Mar 6)
Kano M, Hanari N, Gunji H, Hayano K, Hayashi H, Matsubara H (2017) Is, “functional end-to-end anastomosis” really functional? A review of the literature on stapled anastomosis using linear staplers. Surg Today 47(1):1–7 (Epub 2016 Mar 17)
de van BuckOverstraeten A, Eshuis EJ, Vermeire S, Van Assche G, Ferrante M, D’Haens GR, Ponsioen CY, Belmans A, Buskens CJ, Wolthuis AM, Bemelman WA, D’Hoore A (2017) Short- and medium-term outcomes following primary ileocaecal resection for Crohn’s disease in two specialist centres. Br J Surg 104(12):1713–1722. https://doi.org/10.1002/bjs.10595 (Epub 2017 Jul 26)
Neary PM, Aiello AC, Stocchi L, Shawki S, Hull T, Steele SR, Delaney CP, Holubar SD (2019) High-risk ileocolic anastomoses for Crohn’s disease: when is diversion indicated? J Crohns Colitis 13(7):856–863. https://doi.org/10.1093/ecco-jcc/jjz004
Garofalo E, Lucarini A, Flashman KG, Celentano V (2019) A positive proximal resection margin is associated with anastomotic complications following primary ileocaecal resection for Crohn’s disease. Int J Colorectal Dis 34(9):1585–1590
Coffey CJ, Kiernan MG, Sahebally SM, Jarrar A, Burke JP, Kiely PA, Shen B, Waldron D, Peirce C, Moloney M, Skelly M, Tibbitts P, Hidayat H, Faul PN, Healy V, O’Leary PD, Walsh LG, Dockery P, O’Connell RP, Martin ST, Shanahan F, Fiocchi C, Dunne CP (2018) Inclusion of the mesentery in ileocolic resection for Crohn’s disease is associated with reduced surgical recurrence. J Crohns Colitis 12(10):1139–1150
Buskens CJ, de Groof EJ, Bemelman WA, Wildenberg ME (2017) The role of the mesentery in Crohn’s disease. Lancet Gastroenterol Hepatol 2(4):245–246
Acknowledgements
The SICCR Current status of Crohn’s disease surgery collaboratives are: Valerio Celentano, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom; University of Portsmouth, Portsmouth, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom; Gianluca Pellino, Lucio Selvaggi, Guido Sciaudone, Francesco Selvaggi, Department of Advanced Medical and Surgical Science, Universita’ degli Studi della Campania Luigi Vanvitelli. Naples, Italy; Matteo Rottoli, Gilberto Poggioli, Marta Tanzanu, Surgery of the Alimentary Tract, Sant'Orsola Hospital, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy; Giuseppe Sica, Michela Campanelli, Minimally Invasive and Gastro-Intestinal Surgical Unit, Department of Surgery, Policlinico Tor Vergata, Rome, Italy; Mariano Cesare Giglio,Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy; Claudio Coco, Gianluca Rizzo, Francesco Sionne,U.O.C. Chirurgia Generale 2 - Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Università Cattolica del Sacro Cuore - Rome, Italy; Francesco Colombo, Gianluca Sampietro, Giulia Lamperti, Diego Foschi, IBD Surgical Unit, Luigi Sacco University Hospital, Milan, Italy; Ferdinando Ficari, Ludovica Vacca, Marta Cricchio, Francesco Giudici, IBD Unit, Careggi University Hospital, Florence, Italy; Roberto Peltrini, Andrea Manfreda, Luigi Bucci, University of Naples Federico II, Naples, Italy; Raffaele Galleano, Omar Ghazouani,Santa Corona Hospital, Pietra Ligure, Italy; Luigi Zorcolo, Simona Deidda, Angelo Restivo, Colon and Rectal Surgery Unit, University of Cagliari, Italy; Andrea Braini, Friuli Occidentale Hospital, Pordenone, Italy; Francesca Di Candido, Matteo Sacchi, Michele Carvello, Stefania Martorana, Antonino Spinelli, Humanitas Clinical and Research Center IRCCS, Division of Colon and Rectal Surgery, Via Manzoni 56 20089 Rozzano, Milano – Italy; Giovanni Bordignon, Imerio Angriman,Surgical Unit, Department of Surgical Oncological and Gastroenterological Sciences University of Padova. Padova, Italy; Angela Variola, Mirko Di Ruscio, Giuliano Barugola, Andrea Geccherle, IRCCS "Sacro Cuore - Don Calabria" , Negrar (Vr), Italy; Francesca Paola Tropeano, Gaetano Luglio, Department of Public Health, University of Naples Federico II, Naples, Italy; Diego Sasia, Marco Migliore, Maria Carmela Giuffrida, Department of Surgery. Santa Croce e Carle Hospital, Cuneo, Italy; Enrico Marrano, Gianluigi Moretto, Harmony Impellizzeri, GianGaetano Delaini, Department of Surgery, "Pederzoli" Hospital, Peschiera del Garda, Verona, Italy; Gaetano Gallo, Giuseppina Vescio, Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy; Giuseppe Sammarco, Department of Health sciences, University of Catanzaro, Catanzaro, Italy; Giovanni Terrosu, Giacomo Calini,Department of Surgery, University Hospital “Santa Maria della Misericordia”, Udine, Italy; Andrea Bondurri, Anna Maffioli., MD, Gloria Zaffaroni,Unit 1, General Surgery, Luigi Sacco University Hospital, Milan, Italy; Andrea Resegotti, Massimiliano Mistrangelo, Marco Ettore Allaix, Department of Surgical Sciences, Citta della Salute e della Scienza di Torino, Presidio Molinette, University Hospital, Turin, Italy; Fiorenzo Botti, Matteo Prati, Luigi Boni, Department of General Surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Serena Perotti, Michela Mineccia,Division of General and Oncologic Surgery, Mauriziano Hospital, Turin, Italy; Antonio Giuliani, Lucia Romano,San Salvatore Hospital. Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila. L’Aquila, Italy; Giorgio Maria Paolo Graziano, Luigi Pugliese, Andrea Pietrabissa, Fondazione IRCCS Policlinico San Matteo di Pavia, Università degli Studi di Pavia, Pavia, Italy; Antonino Spinelli,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele Milano, Italy
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Celentano, V., Pellino, G., Spinelli, A. et al. Anastomosis configuration and technique following ileocaecal resection for Crohn’s disease: a multicentre study. Updates Surg 73, 149–156 (2021). https://doi.org/10.1007/s13304-020-00918-z
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DOI: https://doi.org/10.1007/s13304-020-00918-z