Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2592-2601
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2592
New anti-mesenteric delta-shaped stapled anastomosis: Technical report with short-term postoperative outcomes in patients with Crohn’s disease
Jong Lyul Lee, Yong Sik Yoon, Hyun Gu Lee, Young Il Kim, Min Hyun Kim, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu
Jong Lyul Lee, Yong Sik Yoon, Young Il Kim, Min Hyun Kim, Chan Wook Kim, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, South Korea
Hyun Gu Lee, Department of Surgery, Gangdong Kyung Hee University Hospital, Seoul 05278, South Korea
Author contributions: Lee JL designed and performed the research, and wrote the paper; Yoon YS designed the research and supervised the report generation; Lee HG contributed to the analysis; Kim YI, Kim MH, Kim CW, Park IJ, Lim SB, and Yu CS provided clinical advice and supervised the report. All authors read and approved the final manuscript.
Supported by Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea, No. 2019IF0593.
Institutional review board statement: The Institutional Review Board of Asan Medical Center provided approval for this study (IRB No. 2024-0322).
Informed consent statement: Due to the retrospective nature of this study, informed consent was waived.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The anonymized data that support the findings of this study are available from the corresponding author (Yong-Sik Yoon, yoonys@amc.seoul.kr) upon reasonable request. The unanonymized data, however, will not be made publicly available due to their information content that could compromise the privacy of research participants.
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: Yong Sik Yoon, MD, PhD, Professor, Division of Colon and Rectal Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. yoonys@amc.seoul.kr
Received: April 30, 2024
Revised: June 19, 2024
Accepted: July 17, 2024
Published online: August 27, 2024
Processing time: 108 Days and 7.3 Hours
Abstract
BACKGROUND

Medical treatment for Crohn’s disease (CD) has continuously improved, which has led to a decrease in surgical recurrence rates. Despite these advancements, 25% of patients will undergo repeat intestinal surgery. Recurrence of CD commonly occurs on the mesentery side of the anastomosis site.

AIM

To compare the new anti-mesenteric side-to-side delta-shaped stapled anastomosis (DSA) with the conventional stapled functional end-to-end anastomosis (CSA).

METHODS

This retrospective study included CD patients who underwent ileo-ileal or ileo-colic anastomosis between January 2020 and December 2023. The DSA technique employed a stapler to maintain the concept of anti-mesentery side-to-side anastomosis by performing a 90° vertical closure of the open window compared with the CSA technique. At the corner where the open window is closed, the DSA avoids forming a pouch and creates an anastomosis resembling a delta shape within the intestinal lumen. We compared demographics, preoperative condition, operative findings, and operative outcomes for the two techniques.

RESULTS

The study included 175 patients, including 92 in the DSA group and 83 in the CSA group. The two groups were similar in baseline characteristics, preoperative medical treatment, and operative findings except for the Montreal classification location. The 30-days postoperative complication rate was significantly lower in the DSA group compared with the CSA group (16.3% vs 32.5%, P = 0.009). Ileus incidence was significantly lower in the DSA group than in the CSA group (4.3% vs 14.5%, P = 0.033), and the hospital stay was shorter in the DSA group than in the CSA group (5.67 ± 1.53 days vs 7.39 ± 3.68 days, P = 0.001).

CONCLUSION

The DSA technique was feasible and showed comparable postoperative outcomes with lower short-term complications compared with the CSA technique. Further studies on CD recurrence and long-term complications are warranted.

Keywords: Crohn’s disease; Surgery; Anastomosis; Complication; Recurrence

Core Tip: This study introduced a new anti-mesenteric side-to-side delta-shaped stapled anastomosis (DSA) technique employed to maintain the concept of anti-mesentery anastomosis by performing a 90° vertical closure of the open window. The DSA technique avoids pouch formation at the corner and creates a delta-shaped anastomosis within the intestinal lumen. Patients with Crohn’s disease who underwent intestinal surgery using the DSA technique had a significantly shorter hospital stay and a lower rate of postoperative complication compared with those who underwent conventional side-to-side anastomosis. The DSA technique appears to be a safe and more suitable anastomosis technique for surgical treatment of Crohn’s disease.