Redo Ileocolic Resection Is Not an Independent Risk Factor for Anastomotic Leak in Recurrent Crohn’s Disease

Abstract

BACKGROUND:Redo ileocolic resection for recurrent Crohn's disease is associated with increased technical complexity and higher complication rates compared to primary resection. Literature concerning redo surgery for recurrent Crohn's disease is scarce and it is controversial whether a redo is a risk factor for postoperative anastomotic leak. OBJECTIVE:This study aimed to hypothesized that redo ileocolic resection for Crohn's disease is an independent risk factor for anastomotic leak.DESIGN: Retrospective, case-control study from 1994 to 2019 with multivariate analysis and propensity score weighting.SETTING: Quaternary, IBD-referral center.PATIENTS: Adult patients aged >18 years were included in the study. INTERVENTIONS:Primary or redo ileocolic resection with an anastomosis, with or without diverting ileostomy. MAIN OUTCOME MEASURES: Thirty-day anastomotic leak rate.RESULTS: A total of 991 patients (56% primary and 44% redo ileocolic resections) were included. Patients who underwent redo resection were significantly older with more comorbidities, fewer medications, and less fistulizing disease compared to the primary group. On univariate analysis, patients who underwent redo resection had more overall complications (50.5% vs 36.2%, p < 0.001), and the cumulative number of prior ileocolic resections was significantly associated with increased risk for overall morbidity (p < 0.001). There were 31 (3%) anastomotic leaks; leak rates did not differ between groups (p = 0.60). Multivariable analysis indicated that extensive adhesiolysis (p < 0.001), ileostomy omission (p = 0.009), and intraoperative abscess/fistula (p = 0.02) were independently associated with leaks but not redo resection (p = 0.27). Patients with 0, 1, 2, or 3 of these risk factors had observed leak rates of 1.1%, 1.3%, 6.0%, and 11.6.% (p = 0.03), respectively. LIMITATIONS:The limitations of this study were selection bias, referral bias, and single quaternary center.CONCLUSIONS: Compared to primary procedures, redo ileocolic resection for recurrent Crohn's disease is associated with increased overall morbidity but not anastomotic leak.

Predicting short-term major postoperative complications in intestinal resection for Crohn’s disease: A machine learning-based study

“…Some authors have found that repeat bowel resection increases the risk of postoperative anastomotic fistula in patients with CD[ 50 , 51 ], but as with two other recent studies[ 46 , 52 ], this did not appear in our study. We believe that even complex surgeries, including repeated bowel resection and anastomosis, can be performed with low postoperative morbidity, as long as perioperative preparations are made carefully.…”

A nomogram to predict stoma creation in elective surgical resection for penetrating Crohn's disease

“…12 Surgeons who encounter anastomotic fistulas derive advantages from the presence of a pre-existing anastomosis, as it facilitates the planning and execution of the surgical repair with greater efficacy. 13 This advantage ultimately contributes to enhanced management of anastomotic fistulas in these patients.…”

“…These fistulas commonly arise at the site of a previous surgical connection between two segments of the intestine, predominantly occurring in the small bowel or colon 12 . Surgeons who encounter anastomotic fistulas derive advantages from the presence of a pre‐existing anastomosis, as it facilitates the planning and execution of the surgical repair with greater efficacy 13 . This advantage ultimately contributes to enhanced management of anastomotic fistulas in these patients.…”

A nomogram to predict stoma creation in elective surgical resection for penetrating Crohn's disease

“…These stulas commonly arise at the site of a previous surgical connection between two segments of the intestine, predominantly occurring in the small bowel or colon [14]. Surgeons who encounter anastomotic stulas derive advantages from the presence of a pre-existing anastomosis, as it facilitates the planning and execution of the surgical repair with greater e cacy [15]. This advantage ultimately contributes to enhanced management of anastomotic stulas in these patients.…”