Anastomotic Configuration and Temporary Diverting Ileostomy Do Not Increase Risk of Anastomotic Stricture in Postoperative Crohn's Disease

Abstract

Background: Surgical management of Crohn’s disease (CD) is common. Postoperative complications include anastomotic stricturing (AS). The natural history and risk factors for AS has not been elucidated. Methods: A retrospective cohort study of patients with CD who underwent ileocolonic resection (ICR) with ≥1 postoperative ileocolonoscopy between 2009-2020. Postoperative ileocolonoscopies with corresponding cross-sectional imaging were evaluated for evidence of AS without neoterminal ileal extension. Severity of AS and endoscopic intervention at time of detection were collected. Primary outcome was development of AS. Secondary outcome was time to AS detection. Results: 602 adult patients with CD underwent ICR with postoperative ileocolonoscopy. Of these 426 had primary anastomosis and 136 had temporary diversion at time of ICR. Anastomotic configuration consisted of 308 side-to-side, 148 end-to-side, and 136 end-to-end. 110 (18.3%) patients developed AS with median time of 3.2 years to AS detection. AS severity at time of detection was associated with need for repeat surgical resection for AS. On multivariable cox proportional hazard regression, anastomotic configuration and temporary diversion were not associated with risk for or time to AS. Preoperative stricturing disease was associated with decreased time to AS (aHR 1.8; p=0.049). Endoscopic ileal recurrence prior to AS was not associated with subsequent AS detection. Conclusion: AS is a relatively common postoperative CD complication. Patients with prior stricturing disease behavior are at increased risk for AS. Anastomotic configuration, temporary diversion, and ileal CD recurrence do not increase risk for AS. Early detection and intervention for AS may help prevent progression to repeat ICR.

Intestinal strictures in Crohn's disease: An update from 2023

“…In 2023, multiple studies were conducted to assess the effectiveness of existing management strategies and investigate potential new anti‐fibrotic treatments (Table 4 ). 23 , 73 , 74 , 75 , 76 , 77 , 78 , 80 , 81 , 82 , 83 …”