Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3253-3260
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3253
Surgical and non-surgical risk factors affecting the insufficiency of ileocolic anastomosis after first-time surgery in Crohn’s disease patients
Jaroslaw Cwaliński, Filip Lorek, Łukasz Mazurkiewicz, Michał Mazurkiewicz, Wojciech Lizurej, Jacek Paszkowski, Hanna Cholerzyńska, Wiktoria Zasada
Jaroslaw Cwaliński, Filip Lorek, Łukasz Mazurkiewicz, Michał Mazurkiewicz, Wojciech Lizurej, Jacek Paszkowski, Hanna Cholerzyńska, Wiktoria Zasada, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan 60-355, Poland
Author contributions: Cwaliński J conducted study conception and design; Mazurkiewicz Ł, Mazurkiewicz M, and Lizurej W conducted data collection; Cwaliński J, Mazurkiewicz Ł, Mazurkiewicz M, and Lizurej W analysis and interpretation of results; Cwaliński J, Lorek F, Paszkowski J, Cholerzyńska H, and Zasada W conducted draft manuscript preparation. All authors reviewed the results and approved the final version of the manuscript.
Institutional review board statement: Given the retrospective nature of our study design, it did not necessitate independent approval from the regional bioethics committee.
Informed consent statement: The therapeutic interventions adhered strictly to the principles of medical ethics and the standards of good medical practice. Given the retrospective nature of our study design, it did not necessitate independent approval from the regional bioethics committee. Prior to any medical procedures, patients provided informed written consent.
Conflict-of-interest statement: All authors declare no conflict of interest regarding this manuscript.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jaroslaw Cwaliński, MD, PhD, Research Scientist, Surgeon, Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Przybyszewskiego 49, Poznan 60-355, Poland. jaroslaw.cwalinski@usk.poznan.pl
Received: April 26, 2024
Revised: July 20, 2024
Accepted: August 1, 2024
Published online: October 27, 2024
Processing time: 154 Days and 16.5 Hours
Abstract
BACKGROUND

Crohn's disease (CD) often necessitates surgical intervention, particularly when it manifests in the terminal ileum and ileocecal valve. Despite undergoing radical surgery, a subset of patients experiences recurrent inflammation at the anastomotic site, necessitating further medical attention.

AIM

To investigate the risk factors associated with anastomotic insufficiency following ileocecal resection in CD patients.

METHODS

This study enrolled 77 patients who underwent open ileocolic resection with primary stapled anastomosis. Patients were stratified into two groups: Group I comprised individuals without anastomotic insufficiency, while Group II included patients exhibiting advanced anastomotic destruction observed endoscopically or those requiring additional surgery during the follow-up period. Surgical and non-surgical factors potentially influencing anastomotic failure were evaluated in both cohorts.

RESULTS

Anastomotic insufficiency was detected in 12 patients (15.6%), with a mean time interval of 30 months between the initial surgery and recurrence. The predominant reasons for re-intervention included stenosis and excessive perianastomotic lesions. Factors associated with a heightened risk of anastomotic failure encompassed prolonged postoperative obstruction, anastomotic bleeding, and clinically confirmed micro-leakage. Additionally, patients in Group II exhibited preoperative malnutrition and early recurrence of symptoms related to CD.

CONCLUSION

Successful surgical outcomes hinge on the attainment of a fully functional anastomosis, optimal metabolic status, and clinical remission of the underlying disease. Vigilant endoscopic surveillance following primary resection facilitates the timely identification of anastomotic failure, thereby enabling noninvasive interventions.

Keywords: Crohn’s disease; Ileocolic resection; Anastomotic insufficiency; Endoscopic surveillance; Surgery; Risk factors

Core Tip: Our study underscores the critical role of surgical intervention in managing Crohn's disease (CD) complications. Notably, we emphasize the importance of meticulous patient selection, precise surgical techniques, and comprehensive postoperative care to mitigate recurrence risks. Key findings reveal the significance of achieving a wide, fully functional anastomosis, maintaining metabolic balance, and achieving clinical remission. Moreover, our study highlights the value of organized endoscopic surveillance in early detection of anastomotic failure, facilitating minimally invasive interventions. These insights promise to enhance CD management, reducing recurrence rates and improving patient outcomes.