Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study
Objective:. Analyze our long-term experience with a less-popularized but stalwart approach, the stapled end-to-side ileocolic anastomosis. Background:. The choice of technical approach to ileocolic anastomosis after ileocecal resection for Crohn’s disease affects surgical outcomes and recurrence. Ye...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Health
2024-03-01
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| Series: | Annals of Surgery Open |
| Online Access: | http://journals.lww.com/10.1097/AS9.0000000000000374 |
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| author | Volkan Doğru, MD Jean H. Ashburn, MD Umut Akova, BS Alton G. Sutter, MD Eren Esen, MD Emily M. Gardner, MD Andre da Luz Moreira, MD Arman Erkan, MD John Kirat, MD Michael J. Grieco, MD Feza H. Remzi, MD |
| author_facet | Volkan Doğru, MD Jean H. Ashburn, MD Umut Akova, BS Alton G. Sutter, MD Eren Esen, MD Emily M. Gardner, MD Andre da Luz Moreira, MD Arman Erkan, MD John Kirat, MD Michael J. Grieco, MD Feza H. Remzi, MD |
| author_sort | Volkan Doğru, MD |
| collection | DOAJ |
| description | Objective:. Analyze our long-term experience with a less-popularized but stalwart approach, the stapled end-to-side ileocolic anastomosis.
Background:. The choice of technical approach to ileocolic anastomosis after ileocecal resection for Crohn’s disease affects surgical outcomes and recurrence. Yet, despite heterogeneous data from different anastomotic configurations, there remains no clear guidance as to the optimal technique.
Methods:. In a retrospective cohort design, patients undergoing ileocolic anastomosis in the setting of Crohn’s disease between 2016 and 2021 at two institutions were identified. Patient characteristics and surgical outcomes in terms of recurrence (surgical, clinical, and endoscopic) were studied.
Results:. In total, 211 patients were included. Before surgery, 80% were exposed to at least 1 cycle of systemic steroids and 71% had at least 1 biologic agent; 60% exhibited penetrating disease and 38% developed an intra-abdominal abscess. After surgery, one anastomosis leaked (0.5%). Over 2.4 years of follow-up (IQR = 1.3–3.9), surgical recurrence was 0.9%. Two-year overall recurrence-free and endoscopic recurrence-free survivals were 74% and 85% (95% CI = 68–81 and 80–91), respectively. The adjusted hazard ratio of endoscopic recurrence was 3.0 (95% CI = 1.4–6.2) for males and 5.2 (1.2–22) for patients who received systemic steroids before the surgery.
Conclusion:. The stapled end-to-side anastomosis is an efficient, reliable, and reproducible approach to maintain bowel continuity after ileocecal resection with durable outcomes. Our outcomes demonstrate low rates of disease recurrence and stand favorably in comparison to other more technically complex or protracted anastomotic approaches. This anastomosis is an ideal reconstructive approach after ileocecal resection for Crohn’s disease. |
| format | Article |
| id | doaj-art-2d59e46d9b31404b949d35cca471f513 |
| institution | Kabale University |
| issn | 2691-3593 |
| language | English |
| publishDate | 2024-03-01 |
| publisher | Wolters Kluwer Health |
| record_format | Article |
| series | Annals of Surgery Open |
| spelling | doaj-art-2d59e46d9b31404b949d35cca471f5132025-01-24T09:18:25ZengWolters Kluwer HealthAnnals of Surgery Open2691-35932024-03-0151e37410.1097/AS9.0000000000000374202403000-00021Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort StudyVolkan Doğru, MD0Jean H. Ashburn, MD1Umut Akova, BS2Alton G. Sutter, MD3Eren Esen, MD4Emily M. Gardner, MD5Andre da Luz Moreira, MD6Arman Erkan, MD7John Kirat, MD8Michael J. Grieco, MD9Feza H. Remzi, MD10From the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY† Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, NC.From the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY† Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, NC.From the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY† Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, NC.From the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NYFrom the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NYFrom the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NYFrom the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NYFrom the * Inflammatory Bowel Disease Center, NYU Langone Health, New York, NYObjective:. Analyze our long-term experience with a less-popularized but stalwart approach, the stapled end-to-side ileocolic anastomosis. Background:. The choice of technical approach to ileocolic anastomosis after ileocecal resection for Crohn’s disease affects surgical outcomes and recurrence. Yet, despite heterogeneous data from different anastomotic configurations, there remains no clear guidance as to the optimal technique. Methods:. In a retrospective cohort design, patients undergoing ileocolic anastomosis in the setting of Crohn’s disease between 2016 and 2021 at two institutions were identified. Patient characteristics and surgical outcomes in terms of recurrence (surgical, clinical, and endoscopic) were studied. Results:. In total, 211 patients were included. Before surgery, 80% were exposed to at least 1 cycle of systemic steroids and 71% had at least 1 biologic agent; 60% exhibited penetrating disease and 38% developed an intra-abdominal abscess. After surgery, one anastomosis leaked (0.5%). Over 2.4 years of follow-up (IQR = 1.3–3.9), surgical recurrence was 0.9%. Two-year overall recurrence-free and endoscopic recurrence-free survivals were 74% and 85% (95% CI = 68–81 and 80–91), respectively. The adjusted hazard ratio of endoscopic recurrence was 3.0 (95% CI = 1.4–6.2) for males and 5.2 (1.2–22) for patients who received systemic steroids before the surgery. Conclusion:. The stapled end-to-side anastomosis is an efficient, reliable, and reproducible approach to maintain bowel continuity after ileocecal resection with durable outcomes. Our outcomes demonstrate low rates of disease recurrence and stand favorably in comparison to other more technically complex or protracted anastomotic approaches. This anastomosis is an ideal reconstructive approach after ileocecal resection for Crohn’s disease.http://journals.lww.com/10.1097/AS9.0000000000000374 |
| spellingShingle | Volkan Doğru, MD Jean H. Ashburn, MD Umut Akova, BS Alton G. Sutter, MD Eren Esen, MD Emily M. Gardner, MD Andre da Luz Moreira, MD Arman Erkan, MD John Kirat, MD Michael J. Grieco, MD Feza H. Remzi, MD Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study Annals of Surgery Open |
| title | Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study |
| title_full | Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study |
| title_fullStr | Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study |
| title_full_unstemmed | Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study |
| title_short | Stapled End-To-Side Ileocolic Anastomosis in Crohn’s Disease: Old Dog, Reliable Tricks? A Retrospective Two-Center Cohort Study |
| title_sort | stapled end to side ileocolic anastomosis in crohn s disease old dog reliable tricks a retrospective two center cohort study |
| url | http://journals.lww.com/10.1097/AS9.0000000000000374 |
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