Ileorectal anastomosis in patients with Crohn’s disease. Postoperative complications and functional outcome—a systematic review

Abstract

Aim The objective of this systematic review was to investigate the outcomes of ileorectal anastomosis (IRA) in Crohn’s disease and to clarify whether there are any time‐related trends in outcome measures. The primary outcomes are risk of anastomotic leakage, death, clinical recurrence and subsequent diverting or permanent stoma and/or proctectomy. Secondary end‐points are quality of life and functional outcome. Methods Systematic searches were conducted using the Cochrane Library, Embase and MEDLINE. The complete search strategy is uploaded online at http://www.crd.york.ac.uk/prospero/. Human studies in English with over five subjects were included and no limit was set regarding the date of publication. All relevant studies were screened by two reviewers. The web‐based software platform http://www.covidence.org was used for primary screening of the title, abstract, full‐text review and data extraction. Results The search identified 2231 unique articles. After the screening process, 37 remained. Key results were an overall anastomotic leak rate of 6.4%; cumulative rates of clinical recurrence of 43% and 67% at 5 and 10 years, respectively; an overall rate of proctectomy of 18.9%; and subsequent ileostomy required in 18.8%. Only one study presented useful data on quality of life. Recurrence rates remained stable over time. A small decline in the anastomotic leak rate was found. Conclusions Only minor improvements in the outcomes of IRA in patients with Crohn´s disease have occurred during the past 50 years regarding anastomotic leakage and recurrence, except for a slight increase in the rate of a functioning IRA. These results call for implementation guidelines in patient selection for IRA and postoperative medical treatment and follow‐up.

Profile of Surgeons Who Treat Inflammatory Bowel Diseases in Brazil

“…12,13 Although indication for surgery due to clinical treatment failure has decreased in the past 60 years, a recent meta-analysis found that it still remains high: 47% 5 years after diagnosis. 14,15 Patients who are intolerant to or with poor adherence to clinical treatment, with corticosteroid dependency, refractory to drug treatment, or with primary or secondary treatment failure may benefit from surgical treatment. 14 Patients with colonic CD have a 2-3 times greater risk of colorectal cancer, for which the risk factors include: extensive disease, disease duration, family risk of colorectal cancer, and primary sclerosing cholangitis.…”

Long‐term outcomes of total colectomy for severe constipation

“…The present study has results that are consistent with the current body of evidence for TCIRA as a treatment for constipation. Individual studies may present varying results; however, the overall picture is that of patient satisfaction with surgery despite heterogeneous functional outcomes with frequent continuation of pain and bloating symptoms and the possibility for very poor functional outcomes [5‐10,16,17,19,22‐27].…”

“…Individual studies may present varying results; however, the overall picture is that of patient satisfaction with surgery despite heterogeneous functional outcomes with frequent continuation of pain and bloating symptoms and the possibility for very poor functional outcomes [5][6][7][8][9][10]16,17,19,[22][23][24][25][26][27].…”

Anastomotic Considerations in Crohn's Disease

“…A systematic review published in 2021 that included 37 studies assessing the outcome of ileorectal anastomosis in Crohn's disease found a cumulative anastomotic leak rate of 6.4%, cumulative rates of clinical recurrence of 43% at 5 years and 67% at 10 years, and an overall rate of proctectomy of 18.9%. 65 The authors also reported only minor improvements in outcomes for ileorectal anastomosis in the setting of Crohn's disease over the past 50 years, in spite of the advances in the medical management of Crohn's disease over this time frame.…”