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Wide-lumen stapled anastomosisvs. conventional end-to-end anastomosis in the treatment of Crohn's disease

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Diseases of the Colon & Rectum

Abstract

PURPOSE: Preanastomotic recurrence and stricturing after surgery for ileocolic Crohn's disease is a frequent, unexplained phenomena that may lead to prompt reoperation. The aim of this study was to determine whether a wide-lumen stapled anastomosis (side-to-side, functional end-to-end) provides better outcome than a conventional sutured end-to-end anastomosis METHOD: A case-control comparative analysis of patients with Crohn's disease from two inflammatory bowel disease centers treated with wide-lumen stapled anastomosis and a matched (age and gender) group treated with conventional sutured end-to-end anastomosis was performed. RESULTS: A total of 138 patients with Crohn's disease were treated, 69 with wide-lumen stapled anastomosis and 69 with conventional sutured end-to-end anastomosis. Preoperative therapy, number of previous resections, indication for operation, and length of bowel resected were similar in both groups. Fewer complications occurred after wide-lumen stapled anastomosis (P=0.048). A total of 55 patients developed recurrent Crohn's disease symptoms, 39 (57 percent) in the conventional sutured end-to-end anastomosis and 16 (24 percent) in the wide-lumen stapled anastomosis group. Median follow-up was 70 and 46 months, respectively. After conventional sutured end-to-end anastomosis 18 reoperations were required, 15 for anastomotic stricture and 3 for fistulization. After wide-lumen stapled anastomosis three reoperations were necessary, two for stricture and one for fistulization. The cumulative reoperation rate for anastomotic recurrence was significantly lower (P=0.017; log-rank test) for the wide-lumen stapled anastomosis group. CONCLUSION: Wide-lumen stapled anastomosis is as safe as conventional sutured end-to-end anastomosis and results in a lower incidence of symptomatic recurrent Crohn's disease and need for reoperation. Further prospective study of the wide-lumen stapled anastomosis technique is necessary to define the precise role of this operation in patients with Crohn's disease.

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Authors and Affiliations

  1. From the Division of Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota

    Manuel Muñoz-Juárez M.D. &  Bruce G. Wolff M.D.

  2. University Department of Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom

    Takayuki Yamamoto M.D. & Michael R. B. Keighley F.R.C.S.

Authors
  1. Manuel Muñoz-Juárez M.D.
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  2. Takayuki Yamamoto M.D.
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  3. Bruce G. Wolff M.D.
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  4. Michael R. B. Keighley F.R.C.S.
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Additional information

Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.

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Muñoz-Juárez, M., Yamamoto, T., Wolff, B.G. et al. Wide-lumen stapled anastomosisvs. conventional end-to-end anastomosis in the treatment of Crohn's disease. Dis Colon Rectum 44, 20–25 (2001). https://doi.org/10.1007/BF02234814

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