STAPLED END-TO-SIDE ILEOCOLIC ANASTOMOSIS IN CROHN'S DISEASE: OLD DOG, RELIABLE TRICKS?
Volkan Do?ru*1, Umut Akova1, Alton Sutter2, Eren Esen1, Emily M. Gardner2, Andre da Luz Moreira1, Arman Erkan1, John Kirat1, Michael J. Grieco1, Feza H. Remzi1, Jean Ashburn2
1Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY; 2Wake Forest Baptist Health, Winston-Salem, NC
Introduction
There has been a flurry of renewed interest in anastomotic technique for Crohn's disease after ileocolic resection (ICR). This has centered around various hand-sewn techniques avoiding anastomotic distortion, narrowing, and apposition of mesentery. We report our experience with the veteran stapled end-to-side anastomotic technique (ESA), a safe, reliable, and efficient technique that avoids the technical pitfalls associated with traditional side-to-side (STS) and end-to-end (ETE) anastomoses. Data on stapled ESA is notably lacking in the literature, and thus we report our outcomes after ESA for ICR in Crohn's disease.
Methods
Patients who underwent ESA after ICR for CD between 2016 and 2021 were included from two IBD center databases. Surgical complications, endoscopic and surgical recurrence rates were reported.
Results
In total, 220 ICR with ESA were included. Median age of the patients were 33 years (IQR: 24-47). The majority of procedures were elective (91%) and laparoscopic (76%). 56 patients (26%) had prior bowel resections and 31 (14%) were undergoing redo ileocolic resection. 112 procedures (51%) involved fistula takedown and abscess formation was present in 82 patients (37%). Twenty eight patients (13%) with conditions not amenable to medical treatments were naive to immunosuppressive agents at the time of surgery; 65% had at least one agent within 12 weeks prior to surgery, with biologics constituting 89% of all agents. 134 patients (60%) were diverted with a loop ileostomy. Median follow up was 2.7 years (IQR 1.4-3.6). Five patients (2.3%) needed reoperation within 30 days; 1 stoma retraction, 1 bleeding from mesentery, 1 surgical site infection, 1 anastomotic failure at an accompanying colorectal anastomosis and 1 anastomotic failure at the ESA (0.4% for each). Biologics were started in 60% of the patients postoperatively, mostly within 6 months (80%). Endoscopic recurrence rate of CD in the study period was 6.3%. Surgical recurrence was 0.9%.
Conclusion
ESA is safe and associated with low recurrence after ICR for CD. This technique avoids inadvertent narrowing during creation as seen with ETE and the bowel loss and crossing staple lines noted with STS. ESA also addresses two critical factors thought to increase risk for recurrence, ischemia and mesenteric apposition to the bowel. ESA reduces the likelihood of relative ischemia and creates a perpendicular orientation of the bowel, which provides mechanical stability with offsetting of the mesenteries. The ESA not been evaluated in comparative trials and warrants further investigation as it likely demonstrates many of the putative advantages of recently investigated novel techniques, but in a more straightforward, efficient technical approach.
Back to 2022 Posters