Skip to main content

Advertisement

SpringerLink
Log in

Complications after end-to-end vs. side-to-side anastomosis in ileocecal Crohn’s disease—early postoperative results from a randomized controlled multi-center trial (ISRCTN-45665492)

  • Controlled Clinical Trial
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Recurrent Crohn’s disease activity at the site of anastomosis after ileocecal resection is of great surgical importance. This prospective randomized multi-center trial with an estimated case number of 224 patients was initially planned to investigate whether stapled side-to-side anastomosis, compared to hand-sewn end-to-end anastomosis, results in a decreased recurrence of Crohn’s disease following ileocolic resection (primary endpoint). The secondary endpoint was to focus on the early postoperative results comparing both surgical methods. The study was terminated early due to insufficient patient recruitment and because another large study investigated the same question, while our trial was ongoing.

Methods and study design

Patients with stenosing ileitis terminalis in Crohn’s disease who underwent an ileocolic resection were randomized to side-to-side or end-to-end anastomosis. Due to its early discontinuation, our study only investigated the secondary endpoints, the early postoperative results (complications: bleeding, wound infection, anastomotic leakage, first postoperative stool, duration of hospital stay).

Results

From February 2006 until June 2010, 67 patients were enrolled in nine participating centers. The two treatment groups were comparable to their demographic and pre-operative data. BMI and Crohn’s Disease Activity Index were 22.2 (±4.47) and 200.5 (±73.66), respectively, in the side-to-side group compared with 23.3 (±4.99) and 219.6 (±89.03) in the end-to-end group. The duration of surgery was 126.7 (±42.8) min in the side-to-side anastomosis group and 137.4 (±51.9) min in the end-to-end anastomosis group. Two patients in the end-to-end anastomosis group developed an anastomotic leakage (6.5%). Impaired wound healing was found in 13.9% of the side-to-side anastomosis group, while 6.5% of the end-to-end anastomosis group developed this complication. The duration of hospital stay was comparable in both groups with 9.9 (±3.93) and 10.4 (±3.26) days, respectively.

Conclusions

Because of the early discontinuation of the study, it is not possible to provide a statement about the perianastomotic recurrence rates regarding the primary endpoint. With regard to the early postoperative outcome, we observed no difference between the two types of anastomosis.

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

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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

    Article  PubMed  CAS  Google Scholar 

  2. Yamamoto T (2005) Factors affecting recurrence after surgery for Crohn’s disease. World J Gastroenterol 11(26):3971–3979

    PubMed  Google Scholar 

  3. Reese GE, Nanidis T, Borysiewicz C, Yamamoto T, Orchard T, Tekkis PP (2008) The effect of smoking after surgery for Crohn’s disease: a meta-analysis of observational studies. Int J Colorectal Dis 23(12):1213–1221

    Article  PubMed  Google Scholar 

  4. Simillis C, Yamamoto T, Reese GE, Umegae S, Matsumoto K, Darzi AW, Tekkis PP (2008) A meta-analysis comparing incidence of recurrence and indication for reoperation after surgery for perforating versus nonperforating Crohn’s disease. Am J Gastroenterol 103(1):196–205

    Article  PubMed  Google Scholar 

  5. Simillis C, Jacovides M, Reese GE, Yamamoto T, Tekkis PP (2010) Meta-analysis of the role of granulomas in the recurrence of Crohn disease. Dis Colon Rectum 53(2):177–185

    Google Scholar 

  6. Simillis C, Purkayastha S, Yamamoto T, Strong SA, Darzi AW, Tekkis PP (2007) A meta-analysis comparing conventional end-to-end anastomosis vs. other anastomotic configurations after resection in Crohn’s disease. Dis Colon Rectum 50(10):1674–1687

    Article  PubMed  Google Scholar 

  7. Egberts JH, Stroeh A, Alkatout I, Goumas FA, Brand PA, Schafmayer C, Becker T, Schniewind B (2011) Preoperative risk evaluation of postoperative morbidity in IBD patients-impact of the POSSUM score. Int J Colorectal Dis 26(6):783–792. doi:10.1007/s00384-011-1179-7

    Article  PubMed  Google Scholar 

  8. Caprilli R, Corrao G, Taddei G, Tonelli F, Torchio P, Viscido A (1996) Prognostic factors for postoperative recurrence of Crohn’s disease. Gruppo Italiano per lo Studio del Colon e del Retto (GISC). Dis Colon Rectum 39(3):335–341

    Article  PubMed  CAS  Google Scholar 

  9. Ikeuchi H, Kusunoki M, Yamamura T (2000) Long-term results of stapled and hand-sewn anastomoses in patients with Crohn’s disease. Dig Surg 17(5):493–496

    Article  PubMed  CAS  Google Scholar 

  10. McLeod RS, Wolff BG, Ross S, Parkes R, McKenzie M (2009) 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

    Article  PubMed  Google Scholar 

  11. Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G (1984) Natural history of recurrent Crohn’s disease at the ileocolonic anastomosis after curative surgery. Gut 25(6):665–672

    Article  PubMed  CAS  Google Scholar 

  12. 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

    Article  PubMed  CAS  Google Scholar 

  13. Hashemi M, Novell JR, Lewis AA (1998) Side-to-side stapled anastomosis may delay recurrence in Crohn’s disease. Dis Colon Rectum 41(10):1293–1296

    Article  PubMed  CAS  Google Scholar 

  14. Resegotti A, Astegiano M, Farina EC, Ciccone G, Avagnina G, Giustetto A, Campra D, Fronda GR (2005) Side-to-side stapled anastomosis strongly reduces anastomotic leak rates in Crohn’s disease surgery. Dis Colon Rectum 48(3):464–468

    Article  PubMed  Google Scholar 

  15. Scarpa M, Angriman I, Barollo M, Polese L, Ruffolo C, Bertin M, D’Amico DF (2004) Role of stapled and hand-sewn anastomoses in recurrence of Crohn’s disease. Hepatogastroenterology 51(58):1053–1057

    PubMed  Google Scholar 

  16. 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

    PubMed  Google Scholar 

  17. Scott NA, Sue-Ling HM, Hughes LE (1995) Anastomotic configuration does not affect recurrence of Crohn’s disease after ileocolonic resection. Int J Colorectal Dis 10(2):67–69

    Article  PubMed  CAS  Google Scholar 

  18. Moskovitz D, McLeod RS, Greenberg GR, Cohen Z (1999) Operative and environmental risk factors for recurrence of Crohn’s disease. Int J Colorectal Dis 14(4–5):224–226

    Article  PubMed  CAS  Google Scholar 

  19. 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, discussion 25–26

    Article  PubMed  CAS  Google Scholar 

  20. Iesalnieks I, Kilger A, Kalisch B, Obermeier F, Schlitt HJ, Agha A (2011) Treatment of the anastomotic complications in patients with Crohn’s disease. Int J Colorectal Dis 26(2):239–244. doi:10.1007/s00384-010-1031-5

    Article  PubMed  Google Scholar 

  21. Cameron JL, Hamilton SR, Coleman J, Sitzmann JV, Bayless TM (1992) Patterns of ileal recurrence in Crohn’s disease. A prospective randomized study. Ann Surg 215(5):546–551, discussion 551–542

    Article  PubMed  CAS  Google Scholar 

  22. Kusunoki M, Ikeuchi H, Yanagi H, Shoji Y, Yamamura T (1998) A comparison of stapled and hand-sewn anastomoses in Crohn’s disease. Dig Surg 15(6):679–682

    Article  PubMed  CAS  Google Scholar 

  23. Rottoli M, Kiran RP, Remzi FH, Shen B, Lavery IC, Fazio VW (2011) Gender of the patient may influence perioperative and long term complications after IPAA. Colorectal Dis. doi:10.1111/j.1463-1318.2011.02634.x

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General, Vascular and Thoracic Surgery, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

    Urte Zurbuchen, Heinz J. Buhr & Jörg-Peter Ritz

  2. Department of General, Visceral and Trauma Surgery, Hospital Porz am Rhein, Cologne, Germany

    Anton J. Kroesen

  3. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Philipp Knebel

  4. Department of General and Visceral Surgery, Trauma and Vascular Surgery, Alfried Krupp Hospital, Essen, Germany

    Michael-Hans Betzler

  5. Department of General and Visceral Surgery, University Medical Centre Goettingen, Goettingen, Germany

    Heinz Becker

  6. Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany

    Hans-Peter Bruch

  7. Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany

    Norbert Senninger

  8. Department of Surgery, University Hospital Mannheim, Mannheim, Germany

    Stefan Post

Authors
  1. Urte Zurbuchen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anton J. Kroesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Philipp Knebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael-Hans Betzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Heinz Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hans-Peter Bruch
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Norbert Senninger
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stefan Post
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Heinz J. Buhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jörg-Peter Ritz
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

German Advanced Surgical Treatment Study Group

Corresponding author

Correspondence to Urte Zurbuchen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zurbuchen, U., Kroesen, A.J., Knebel, P. et al. Complications after end-to-end vs. side-to-side anastomosis in ileocecal Crohn’s disease—early postoperative results from a randomized controlled multi-center trial (ISRCTN-45665492). Langenbecks Arch Surg 398, 467–474 (2013). https://doi.org/10.1007/s00423-012-0904-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-012-0904-1

Keywords

Search

Navigation