Isoperistaltic Anastomosis Increases Neo-Terminal Ileum Intubation Rates in Crohn's Disease Patients

IF 1.7 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-07-21 DOI:10.1016/j.jss.2025.06.082

Tamar Thurm MD , Galia Berman MD , Ayal Hirsch MD , Liat Deutsch MD , Nathaniel Aviv Cohen MD , Haim Leibovitzh MD , Yulia Ron MD , Nadav Dvir MD , Eran Itzkovitz MD , Hagit Tulchinsky MD , Jonathan B. Yuval MD , Yehuda Kariv MD , Guy Lahat MD , Nitsan Maharshak MD , Meir Zemel MD

{"title":"Isoperistaltic Anastomosis Increases Neo-Terminal Ileum Intubation Rates in Crohn's Disease Patients","authors":"Tamar Thurm MD , Galia Berman MD , Ayal Hirsch MD , Liat Deutsch MD , Nathaniel Aviv Cohen MD , Haim Leibovitzh MD , Yulia Ron MD , Nadav Dvir MD , Eran Itzkovitz MD , Hagit Tulchinsky MD , Jonathan B. Yuval MD , Yehuda Kariv MD , Guy Lahat MD , Nitsan Maharshak MD , Meir Zemel MD","doi":"10.1016/j.jss.2025.06.082","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Side-to-side stapled ileocolonic anastomosis (ICA) is commonly used in Crohn's disease (CD). Antiperistaltic ICA (APICA) and isoperistaltic ICA (IPICA) alignments differ in ease of neo-terminal ileum (neo-TI) intubation, potentially impacting endoscopic follow-up. This study compares postsurgical neo-TI intubation feasibility between APICA and IPICA.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective analysis of CD patients (≥18 y) who underwent ileocolonic resection between 2010 and 2022 and completed ileocolonoscopy within 24 mo. Patients with non-APICA/IPICA anastomoses, ileostomy, and patients whose ileocolonoscopy report was unavailable were excluded.</div></div><div><h3>Results</h3><div>We included 148 patients, (76.4% APICA and 23.6% IPICA). Groups were comparable in demographics, surgical factors, and postsurgical outcomes. Anastomotic disease recurrence (Rutgeerts score Ri ≥ 2b) was similar: 37.6% APICA <em>versus</em> 37.1% IPICA (<em>P</em> = 0.563). Excluding patients with anastomotic strictures and poor preparation, neo-TI intubation was successful in 87.4% of APICA <em>versus</em> 100% of IPICA (<em>P</em> = 0.038).</div></div><div><h3>Conclusions</h3><div>APICA and IPICA have similar safety and endoscopic recurrence rates. IPICA allows for easier neo-TI intubation with no intubation failure, improving endoscopic surveillance and management of CD.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"313 ","pages":"Pages 421-430"},"PeriodicalIF":1.7000,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022480425004202","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Introduction

Side-to-side stapled ileocolonic anastomosis (ICA) is commonly used in Crohn's disease (CD). Antiperistaltic ICA (APICA) and isoperistaltic ICA (IPICA) alignments differ in ease of neo-terminal ileum (neo-TI) intubation, potentially impacting endoscopic follow-up. This study compares postsurgical neo-TI intubation feasibility between APICA and IPICA.

Materials and methods

We performed a retrospective analysis of CD patients (≥18 y) who underwent ileocolonic resection between 2010 and 2022 and completed ileocolonoscopy within 24 mo. Patients with non-APICA/IPICA anastomoses, ileostomy, and patients whose ileocolonoscopy report was unavailable were excluded.

Results

We included 148 patients, (76.4% APICA and 23.6% IPICA). Groups were comparable in demographics, surgical factors, and postsurgical outcomes. Anastomotic disease recurrence (Rutgeerts score Ri ≥ 2b) was similar: 37.6% APICA versus 37.1% IPICA (P = 0.563). Excluding patients with anastomotic strictures and poor preparation, neo-TI intubation was successful in 87.4% of APICA versus 100% of IPICA (P = 0.038).

Conclusions

APICA and IPICA have similar safety and endoscopic recurrence rates. IPICA allows for easier neo-TI intubation with no intubation failure, improving endoscopic surveillance and management of CD.

查看原文本刊更多论文

等蠕动吻合术增加克罗恩病患者新末端回肠插管率

侧对侧回肠结肠吻合术（ICA）是治疗克罗恩病（CD）的常用方法。反蠕动ICA （APICA）和等蠕动ICA （IPICA）对齐方式在新回肠末端（neo-TI）插管的便利性方面存在差异，可能影响内镜随访。本研究比较了APICA和IPICA术后neo-TI插管的可行性。材料和方法我们回顾性分析了2010 - 2022年间接受回肠结肠切除术并在24个月内完成回肠结肠镜检查的CD患者（≥18岁）。排除了非apica /IPICA吻合、回肠造口术和无法获得回肠结肠镜检查报告的患者。结果纳入148例患者，其中APICA占76.4%，IPICA占23.6%。各组在人口统计学、手术因素和术后结果方面具有可比性。吻合口疾病复发率（Rutgeerts评分Ri≥2b）相似：APICA为37.6%，IPICA为37.1% （P = 0.563）。排除吻合口狭窄和准备不良的患者，新ti插管成功率为87.4%的APICA和100%的IPICA （P = 0.038）。结论sapica与IPICA的安全性和内镜下复发率相似。IPICA允许更容易的新ti插管，没有插管失败，改善内窥镜监测和管理CD。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.