Surgical predictors of recurrence of Crohn's disease after ileocolonic resection.
OBJECTIVE
Anastomotic recurrence after bowel resection is a major problem in Crohn's disease (CD) surgery. The aims of this retrospective study are to assess the role of anastomotic configuration, the type of suture and the type of surgical approach (laparoscopy-assisted vs laparotomy) in CD recurrence. Secondary end points were to identify any possible predictor that would help the selection of patients for medical prophylaxis.


METHODS
In this retrospective study, we enrolled 141 consecutive patients who had undergone ileocolonic resection for CD. Univariate actuarial analysis was performed according to demographic, clinical and surgical predictors. Variables that resulted to be significant at the univariate analysis were included in two multivariate Cox proportional hazards models that analyzed symptomatic and surgical recurrence, respectively.


RESULTS
In the long-term, handsewn side-to-side anastomosis reported a significantly lower surgical recurrence rate than stapled end-to-side (p < 0.05). At multivariate analysis, anastomosis type, surgical and intestinal complications (p < 0.01) and age at CD onset (p < 0.05) resulted to be significant predictors for re-operation for CD recurrence. Multivariate analysis showed that surgical complication was also a significant predictor of symptomatic recurrence.


CONCLUSIONS
Side-to-side anastomosis configuration seems to delay re-operation and can be assumed as the standard configuration in ileocolonic anastomosis in CD. Post-operative complications and young age at disease onset might be a signal of aggressive CD that may warrant prophylactic pharmacological therapy.
Scarpa
Marco
M
Clinica Chirurgica I, Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Policlinico Universitario, Università di Padova, via Giustiniani 2, 35128 Padova, Italy. marcoscarpa73@yahoo.it
Ruffolo
Cesare
C
Bertin
Eugenia
E
Polese
Lino
L
Filosa
Teresa
T
Prando
Daniela
D
Pagano
Duilio
D
Norberto
Lorenzo
L
Frego
Mauro
M
D'Amico
Davide F
DF
Angriman
Imerio
I
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D055502:Secondary Prevention; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome