Background: Intestinal resection of the terminal ileum followed by ileocolonic anastomosis is the most performed surgery for Crohn's disease (CD). Side-to-side anastomosis is currently recommended by European Crohn’s and Colitis Organisation (ECCO) guidelines, and the laparoscopic method appears to be preferred. However, it remains uncertain whether performing the anastomosis intracorporeally or extracorporeally ultimately affects postoperative outcomes. Currently, no studies are comparing postoperative outcomes in intracorporeally and extracorporeally ileocolonic anastomoses in CD. Therefore, our study aims to investigate any differences in terms of complications, disease activity, body image, quality of life, operating time, and clinical and surgical recurrence-free survival time.
Methods: In this retrospective study, 54 consecutive patients who underwent primary ileocecal resection followed by ileocolonic side-to-side anastomosis in our department from 2020 to 2023 were analyzed. For each patient, clinical and surgical records, and outpatient follow-up visits were thoroughly retrieved. In July-November 2023, 54 patients agreed to participate in a telephone interview to assess patients' clinical disease activity (Harvey-Bradshaw), quality of life (Cleveland Global Quality of Life), and body image (Body Image Questionnaire) after surgery.
Results: In our series, 18 and 36 patients underwent intracorporeal and extracorporeal anastomosis, respectively. We did not observe any difference in terms of postoperative complications and operative timing. At follow-up, the disease activity (Harvey-Bradshaw Index) did not show significant differences in single item or total HBI scores between the two groups. The Body Image Questionnaire (BIQ) results indicated that patients who underwent intracorporeal anastomosis were more satisfied with their bodies (BIQ1, p = 0.021), and tended to feel more attractive (BIQ3, p = 0.046), and more masculine/feminine (BIQ4, p = 0.068) compared to those with extracorporeal anastomosis.
Conclusions: Our study suggests that intracorporeal anastomosis has the same interoperative and postoperative outcome, but it has clear aesthetic advantages compared to extracorporeal anastomosis. In terms of quality of life and disease activity at follow-up, no significant differences were observed between the two types of anastomoses.
