P666 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.

Abstract

Background There is an ongoing debate whether the type of anastomosis following intestinal resection for Crohn’s disease (CD) can have an impact on complications and postoperative recurrence. The aim of the present study is to describe the outcome of side-to-side (S-S) versus end-to-end (E-E) anastomosis after ileocolic resection for CD. Methods A retrospective single center 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 modified Rutgeerts’ score >i2b. Surgical recurrence implied reoperation due to CD activity at the anastomotic site. Modified surgical recurrences was defined as the need for re-operation or balloon-dilation. Perioperative factors related to recurrence were evaluated. Results Of the128 patients included, 52 (40.6%) received an E-E anastomosis. Median follow-up was longer in the E-E group (8.62 vs 13.68 years, p<0.001). Apart from the primary anastomosis, patient, disease and surgical characteristics were similar between both groups. Postoperative complications and anastomotic leak were comparable (S-S 6.6% vs E-E 7.7%, p=1.00). During the entire postoperative follow-up, biologicals were used in 55.3% and 63.5% (p=0.37) in S-S and E-E patients, respectively. Endoscopic recurrence did not differ between S-S and E-E patients (40.8% vs 49.0%, p=0.37). However, at ten years follow-up, surgical and modified surgical recurrence rate were significantly higher in the E-E group (19.7% vs 7.4%, p=0.02 and 39.2% vs 14.1%, p=0.001). Type of anastomosis was the only independent risk factor for surgical and modified surgical recurrence. Conclusion 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 result in a lower risk for balloon dilatation and surgical reintervention in the long-term.

Anastomosis after Bowel Resection for Crohn's Disease: State of the Art Review

“…19 A monocentric European study compared SSSA and HEEA anastomosis and evaluated for endoscopic recurrence at 6 months, highlighting the importance of adequate follow-up to determine the real impact of the anastomotic lumen on surgical recurrence. 10 In the study, endoscopic recurrence and severity were not different between groups (p ¼ 0.37 and p ¼ 0.87, respectively), but higher surgical recurrence (p ¼ 0.04) was observed in the HEEA group during follow-up. 10 In the discussion, the author attributes the findings to the lumen size and configuration.…”

“…10 In the study, endoscopic recurrence and severity were not different between groups (p ¼ 0.37 and p ¼ 0.87, respectively), but higher surgical recurrence (p ¼ 0.04) was observed in the HEEA group during follow-up. 10 In the discussion, the author attributes the findings to the lumen size and configuration.…”

“…19 Bislenghi et al published a retrospective analysis comparing SSSA and HEEA and also demonstrated no difference in endoscopic recurrence at 6 months. 10 However, a higher surgical and modified surgical recurrence was noted in the HEEA group during follow-up. 10 Subsequent retrospective studies in the late 2010s have demonstrated comparable morbidity and recurrence rates (endoscopic, clinical, surgical) between these two groups.…”

“…10 However, a higher surgical and modified surgical recurrence was noted in the HEEA group during follow-up. 10 Subsequent retrospective studies in the late 2010s have demonstrated comparable morbidity and recurrence rates (endoscopic, clinical, surgical) between these two groups. 21,35 Several systematic reviews and meta-analysis have compared SSSA and HEEA.…”

“…8 Stapled antiperistaltic side-to-side anastomosis (SSSA) has become the gold standard for restoration of intestinal continuity after resection for CD. 9 Other options include an isoperistaltic version of the SSSA, handsewn end-to-end anastomosis (HEEA) [10][11][12] that some authors enlarge by spatulating the two ends, end-to-side anastomosis, and more recently, the antimesenteric end-to-end handsewn Kono-S anastomosis (KSA; ►Fig. 1).…”