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Introduction: The safety of stapled anastomoses in resections for Crohn's Disease (CD) has been supported by previous studies as producing comparable if not lower anastomotic leak rates. Nevertheless, the overall rate of anastomotic complications in this cohort remains higher than for non-CD patients. Reinforcing staple-lines by oversewing is one method which may prevent these complications; however, the efficacy of this practice has not been established.
Methods: We performed a retrospective review from 2007-2012 of all patients with Crohn's Disease who underwent primary ileocolic resections (ICR) with stapled anastomoses by faculty at The Mount Sinai Hospital. Baseline characteristics including age, length of stay, operative approach and additional procedures (preoperative abscess drainage, additional intraoperative resections) were assessed. Major anastomotic complications (MACs) were defined as leak, disruption, abscess requiring drainage or reoperation within 30 days. Other postoperative complications (OPCs) were defined as ileus, obstruction resolving with conservative treatment, wound infection, pneumonia, anastomotic hemorrhage and ureteral injury. Chi-square and student's t-test were used to determine baseline differences between the groups, and a logistic regression analysis was used to identify significant predictors of MACs.
Results: A total of 225 patients were studied, 119 with non-oversewn and 106 with oversewn stapled anastomoses. Twelve surgeons were represented. Non-oversewn and oversewn groups were similar in age (34.3 vs. 35.2 years), postoperative length of stay (6.0 vs. 6.4 days), and additional procedures (32% vs. 39.6%). More patients in the non-oversewn group underwent laparoscopic-assisted procedures than in the oversewn group (79% vs. 45.3%, p< 0.001). Overall complication rates (20.2% and 22.6%) and the incidence of OPCs were comparable in both groups, including similar rates of small bowel obstruction and ileus. The incidence of MACs was significantly lower in the oversewn group (2% vs. 13.9%, p =0.004). There were 7 confirmed anastomotic leaks in the non-oversewn group versus none in the oversewn group. Multivariate analysis confirmed that oversewing was an independent predictor of reduced MACs (p<0.0001) whereas approach (laparoscopic versus open) was not.
Conclusion: Oversewing staple-lines in primary ileocolic resections for Crohn's Disease may reduce the rate of major anastomotic complications. The major anastomotic complication rate of 2% in the oversewn group closely parallels that of non-CD patients.