Does the type of anastomosis affect the risk of recurrence in Crohn disease?

Abstract

AIM: to evaluate the effect of intestinal anastomosis type on risk of Crohn’s disease (CD) recurrence.PATIENTS AND METHODS: the retrospective cohort study included 130 patients with CD who underwent surgery for a complicated CD in 2012–2017. Ileocecal resection with anastomosis was performed in 112/130 (86.2%) patients. Resection of the terminal ileum with resection of the right side of the colon with the formation of an ileo-transverse anastomosis. In 18/130 (13.2%) cases. Stapled “side-to-side” anastomosis was formed in 57/130 (43.8%) patients, while hand sewn “end-to-end” — in 73/130 (56.2%) patients. Post-op complications occurred in 21/130 (16.2%) cases. After surgery, most patients were treated by azathioprine as an anti-recurrence therapy — 112/130 (86.2%) patients, while in 31/112 (23.8%) cases, additional biological therapy was done. In 14/130 (10.7%) patients, anti-recurrence therapy was carried out in mono mode with a biological drug.RESULTS: mean follow-up was 28.5 (1.9–95.4) months. Recurrence occurred in 54/130 (41.5%) patients on average 18 ± 5 (12–41) months after surgery. Thus, the operative time exceeding 200 minutes was significantly associated with an increase in the recurrence rate (p = 0.03). It was found that the type of anastomosis does not affect the recurrence risk. Moreover, among the significant factors was the operative time. It increases the chance of recurrence by 2.9 times in the univariate model (p < 0.05), and in the multivariate model — by 6.3 times, when exceeding 155 minutes.CONCLUSION: the type of anastomosis does not affect the recurrence risk. The operation time exceeding 155 minutes increases the chance of recurrence by 6 times (p < 0.01).