Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2015; 7(10): 237-242
Published online Oct 27, 2015. doi: 10.4240/wjgs.v7.i10.237
Risk factors and implications of anastomotic complications after surgery for Crohn’s disease
Kristen T Crowell, Evangelos Messaris
Kristen T Crowell, Evangelos Messaris, Division of Colon and Rectal Surgery, College of Medicine, Pennsylvania State University, Hershey, PA 17033, United States
Author contributions: Both authors contributed equally to the preparation and writing of the manuscript as well as the final approval of the manuscript.
Conflict-of-interest statement: Authors declare no conflicts of interest for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Evangelos Messaris, MD, PhD, FACS, FASCRS, Division of Colon and Rectal Surgery, College of Medicine, Pennsylvania State University, 500 University Drive, H-137, PO Box 850, Hershey, PA 17033, United States.
Telephone: +1-717-5315164 Fax: +1-717-5310646
Received: June 29, 2015
Peer-review started: July 3, 2015
First decision: July 30, 2015
Revised: August 15, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: October 27, 2015

Anastomotic complications occur more frequently in patients with Crohn’s disease leading to postoperative intra-abdominal septic complications (IASC). Patients with IASC often require re-operation or drainage to control the sepsis and have an increased frequency of disease recurrence. The aim of this article was to examine the factors affecting postoperative IASC in Crohn’s disease after anastomoses, since some risk factors remain controversial. Studies investigating IASC in Crohn’s operations were included, and all risk factors associated with IASC were evaluated: nutritional status, presence of abdominal sepsis, medication use, Crohn’s disease type, duration of disease, prior operations for Crohn’s, anastomotic technique, extent of resection, operative timing, operative length, and perioperative bleeding. In this review, the factors associated with an increased risk of IASC are preoperative weight loss, abdominal abscess present at time of surgery, prior operation, and steroid use. To prevent IASC in Crohn’s patients, preoperative optimization with nutritional supplementation or drainage of abscess should be performed, or a diverting stoma should be considered for patients with multiple risk factors.

Keywords: Crohn’s disease, Risk factors, Complications, Resection, Postoperative septic complications, Anastomosis

Core tip: Intra-abdominal sepsis is a common complication in intestinal anastomoses in Crohn’s disease; therefore, identifying the risk factors prior to surgery can improve outcomes. This review identified preoperative weight loss, abdominal abscess present at surgery, prior surgery, and steroid use as risk factors for postoperative anastomotic complications. Outcomes in Crohn’s operations with these risk factors may be improved with preoperative nutritional supplementation and drainage of the intra-abdominal abscess. If multiple risk factors are present and preoperative interventions are not feasible, a diverting stoma should be considered.