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.
Similar content being viewed by others
Data availability
Institutional database. The data underlying this article will be shared on reasonable request to the corresponding author.
References
Ponsioen CY, de Groof EJ, Eshuis EJ, Gardenbroek TJ, Bossuyt PMM, Hart A et al (2017) Laparoscopic ileocaecal resection versus infliximab for terminal ileitis in Crohn’s disease: a randomised controlled, open-label, multicentre trial. Lancet Gastroenterol Hepatol 2(11):785–792
Buisson A, Chevaux JB, Allen PB, Bommelaer G, Peyrin-Biroulet L (2012) Review article: the natural history of postoperative Crohn’s disease recurrence. Aliment Pharmacol Ther 35(6):625–633
Kalman TD, Everhov AH, Nordenvall C, Sachs MC, Halfvarson J, Ekbom A et al (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
Beelen EMJ, van der Woude CJ, Pierik MJ, Hoentjen F, de Boer NK, Oldenburg B et al (2021) Decreasing trends in intestinal resection and re-resection in crohn’s disease: a nationwide cohort study. Ann Surg 273(3):557–563
Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK et al (2019) British society of gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 68(3):s1–s106
Reynolds IS, Doogan KL, Ryan EJ, Hechtl D, Lecot FP, Arya S et al (2021) Surgical strategies to reduce postoperative recurrence of crohn’s disease after ileocolic resection. Front Surg 8:804137
McLeod RS, Wolff BG, Ross S, Parkes R, McKenzie M (2009) Investigators of the CT Recurrence of Crohn’s disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum 52(5):919–927
Thin LWY, Picardo S, Sooben S, Murray K, Ryan J, Wallace MH (2021) Ileocolonic end-to-end anastomoses in crohn’s disease increase the risk of early post-operative endoscopic recurrence in those undergoing an emergency resection. J Gastrointest Surg 25(1):241–251
Munoz-Juarez M, Yamamoto T, Wolff BG, Keighley MR (2001) Wide-lumen stapled anastomosis vs conventional end-to-end anastomosis in the treatment of Crohn’s disease. Dis Colon Rectum 44(1):20–25
Gajendran M, Bauer AJ, Buchholz BM, Watson AR, Koutroubakis IE, Hashash JG et al (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
Tersigni R, Alessandroni L, Barreca M, Piovanello P, Prantera C (2003) Does stapled functional end-to-end anastomosis affect recurrence of Crohn’s disease after ileocolonic resection? Hepatogastroenterology 50(53):1422–1425
Yamamoto T, Bain IM, Mylonakis E, Allan RN, Keighley MR (1999) Stapled functional end-to-end anastomosis versus sutured end-to-end anastomosis after ileocolonic resection in Crohn disease. Scand J Gastroenterol 34(7):708–713
Gklavas A, Dellaportas D, Papaconstantinou I (2017) Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors. Ann Gastroenterol 30(6):598–612
Rutgeerts P, Geboes K, Vantrappen G, Beyls J, Kerremans R, Hiele M (1990) Predictability of the postoperative course of Crohn’s disease. Gastroenterology 99(4):956–963
Riviere P, Vermeire S, Irles-Depe M, Van Assche G, Rutgeerts P, Buck D, van Overstraeten A et al (2019) No change in determining Crohn’s disease recurrence or need for endoscopic or surgical intervention with modification of the rutgeerts’ scoring system. Clin Gastroenterol Hepatol 17(8):1643–1645
Bernell O, Lapidus A, Hellers G (2000) Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease. Br J Surg 87(12):1697–1701
De Cruz P, Kamm MA, Hamilton AL, Ritchie KJ, Krejany EO, Gorelik A et al (2015) Crohn’s disease management after intestinal resection: a randomised trial. Lancet 385(9976):1406–1417
He X, Chen Z, Huang J, Lian L, Rouniyar S, Wu X et al (2014) Stapled side-to-side anastomosis might be better than handsewn end-to-end anastomosis in ileocolic resection for Crohn’s disease: a meta-analysis. Dig Dis Sci 59(7):1544–1551
Ueda T, Koyama F, Nakamoto T, Obara S, Inoue T, Sasaki Y et al (2021) Endoscopic features of postoperative anastomotic lesions in patients with Crohn’s Disease compared with right-side colon cancer: are anastomotic linear superficial ulcers recurrent in crohn’s disease? J Anus Rectum Colon 5(2):158–166
Riviere P, Bislenghi G, Vermeire S, Domenech E, Peyrin-Biroulet L, Laharie D et al (2022) Postoperative Crohn’s Disease recurrence: time to adapt endoscopic recurrence scores to the leading surgical techniques. Clin Gastroenterol Hepatol 20:1201
Hammoudi N, Cazals-Hatem D, Auzolle C, Gardair C, Ngollo M, Bottois H et al (2020) Association between microscopic lesions at ileal resection margin and recurrence after surgery in patients with crohn’s disease. Clin Gastroenterol Hepatol 18(1):141–149
D’Haens GR, Geboes K, Peeters M, Baert F, Penninckx F, Rutgeerts P (1998) Early lesions of recurrent Crohn’s disease caused by infusion of intestinal contents in excluded ileum. Gastroenterology 114(2):262–267
Ha CWY, Martin A, Sepich-Poore GD, Shi B, Wang Y, Gouin K et al (2020) Translocation of viable gut microbiota to mesenteric adipose drives formation of creeping fat in humans. Cell 183(3):666–683
Komatsu S, Nimura Y, Granger DN (1999) Intestinal stasis associated bowel inflammation. World J Gastroenterol 5(6):518–521
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).
Funding
There is no grant support or financial relationship for this manuscript.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Ethical approval
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.
Human and animal rights
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.
Informed Consent
All participants provided informed consent prior to their participation.
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 (e.g. a society or other partner) 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.
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-023-01561-0