Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease.
OBJECTIVE
Anastomotic recurrence after bowel resection is a major problem in Crohn's disease surgery. The aim of this study is to compare recurrence rate after stapled side-to-side ileo-colonic anastomosis to those after stapled end-to-side or hand-sewn side-to-side anastomosis to distinguish the role of suture technique and anastomotic configuration in the prevention of Crohn's disease recurrence.


METHODS
Eighty-four consecutive patients who had undergone ileo-colonic resection for Crohn's disease were enrolled: 12 of them had stapled side-to-side anastomosis, 36 stapled end-to-side anastomosis and 36 hand-sewn side-to-side anastomosis. We evaluated duration of operation, first bowel movement after operation, postoperative hospital staying, postoperative surgical complications, clinical recurrence and reoperation rate. The statistical analysis was performed using Student's t-test and Fisher exact test. Cumulative recurrence rates were compared using F Cox test and Kaplan-Meier method.


RESULTS
No statistically significant difference between the three groups was observed in early postoperative follow up. The stapled side-to-side anastomosis group obtained a better symptom-free survival than the stapled end-to-side group (p=0.04). In the stapled and hand-sewn side-to-side groups reoperation rates were significantly lower than in the stapled end-to-side group (p=0.01 and p=0.05 respectively).


CONCLUSIONS
All the three types of anastomosis were demonstrated to be equally safe in early postoperative outcome. A longer follow-up showed a significantly lower incidence of reoperation recurrence in the stapled and hand-sewn side-to-side anastomosis compared to the stapled end-to-side anastomosis group. This result may suggest the configuration of the anastomosis as the key point in the recurrence of anastomotic Crohn's disease.
Scarpa
Marco
M
Clinica Chirurgica I, Department of Surgical and Gastroenterological Sciences, University of Padova, Italy.
Angriman
Imerio
I
Barollo
Michela
M
Polese
Lino
L
Ruffolo
Cesare
C
Bertin
Matteo
M
D'Amico
Davide F
DF
D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055502:Secondary Prevention; D017792:Surgical Stapling / Q000009:adverse effects / Q000379:methods*; D013536:Suture Techniques / Q000009:adverse effects