Treatment of the anastomotic complications in patients with Crohn's disease.
OBJECTIVE
Postoperative anastomotic complications in patients with Crohn's disease undergoing bowel resections have a detrimental influence on the long-term outcome. The aim of this study was to evaluate whether patients' prognosis is affected by various treatment strategies of anastomotic complications.


METHODS
The term anastomosis-related "intraabdominal septic complication" (IASC) was used for anastomotic leaks, intraabdominal abscesses, anastomotic fistula, peritonitis. Only patients with these complications have been included in the study. Outcome parameters were "surgical recurrence" (i.e., need for repeat bowel resections) and "good surgical outcome" (i.e., no death, no surgical recurrence, no stoma, no enterocutaneous fistula). Patients in group 1 were treated by taking the affected anastomosis down and creating an end stoma. The anastomosis has been preserved in patients of group 2.


RESULTS
Between 1992 and Aug 2009, IASC occurred after 56 ileocolic resections for ileal disease and after 26 resections for Crohn's colitis. In patients with ileal disease, 5-year surgical recurrence rate was lower (0% vs. 65%, p = 0.0020) and a good surgical outcome was achieved more frequently at 2 years (100% vs. 25%, p = 0.0001) in group 1 than in group 2. There was no significant difference of long-term outcome between groups in patients with Crohn's colitis.


CONCLUSIONS
In patients suffering anastomotic complications after ileocolic resection for ileal Crohn's disease, the prognosis can be significantly improved by taking down the anastomosis and creating an end ileostomy. Anastomosis can be preserved without an outcome impairment in many patients with Crohn's colitis.
Iesalnieks
Igors
I
Department of Surgery, University of Regensburg, Regensburg, Germany. i.iesalnieks@marienhospital.eu
Kilger
Alexandra
A
Kalisch
Barbara
B
Obermeier
Florian
F
Schlitt
Hans J
HJ
Agha
Ayman
A
D057868:Anastomotic Leak / Q000209:etiology* / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D003424:Crohn Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery; D012008:Recurrence; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome