title: Oversewing staple lines to prevent anastomotic complications in primary ileocolic resections for Crohn's disease.
abstract: BACKGROUND
  Oversewing staple lines may be a novel way to reduce anastomotic complications after primary ileocolic resections for Crohn's disease (CD).
  
  
  METHODS
  This is a single-institution, non-concurrent cohort study of CD patients undergoing primary ileocolic resections (ICR) with stapled anastomoses from 2007 to 2013. Demographic and clinical characteristics were collected. Propensity scores were calculated for oversewing versus not. Postoperative outcomes within 30 days of surgery were collected. Anastomotic leak, intra-abdominal abscess, small bowel obstruction, and anastomotic bleed were considered major anastomotic complications (MACs). Multivariate analysis controlling for inverse probability weights was used to identify predictors of MACs.
  
  
  RESULTS
  A total of 269 patients were included, of which 120 had undergone oversewing (OS). After controlling for propensity scores, not oversewing (NOS) and OS groups were similar in all preoperative characteristics with the exception of more laparoscopic resections and intracorporeal anastomoses in the NOS group. On univariate analysis, OS was protective against MACs (odds ratio (OR) 0.29, p < 0.01). In a multivariable model using inverse propensity weights and controlling for laparoscopic and intracorporeal approaches, oversewing remained a significant predictor of reduced MACs (OR 0.37, p < 0.001), while intracorporeal anastomoses increased their likelihood (OR 3.7, p < 0.001).
  
  
  CONCLUSIONS
  After controlling for clinical and surgical factors, oversewing staple lines in primary ICRs for CD is correlated with reduced MACs.
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1259, New York, NY, 10029, USA, maria.widmar@mssm.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: Widmar
authors.forename: Dustin R
authors.initials: DR
authors.lastname: Cummings
authors.forename: Emily
authors.initials: E
authors.lastname: Steinhagen
authors.forename: Alana
authors.initials: A
authors.lastname: Samson
authors.forename: Abigail R
authors.initials: AR
authors.lastname: Barth
authors.forename: Adrian J
authors.initials: AJ
authors.lastname: Greenstein
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Greenstein
mesh_terms: D018784:Abdominal Abscess / Q000517:prevention & control; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000517:prevention & control; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007415:Intestinal Obstruction / Q000517:prevention & control; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D057216:Propensity Score; D012189:Retrospective Studies; D017792:Surgical Stapling; D055815:Young Adult