Isoperistaltic Ileocolonic Anastomosis after Ileocecal Resection Reduces Colonoscopic Anastomosis-to-Small-Bowel Time

Aims Side-to-side antiperistaltic ileo-colonic anastomosis (APICA) is wildly used technique in Crohn's disease (CD) patients. Its configuration makes the neo-terminal ileum intubation difficult, and might reduce rates of appropriate scoping, as required for assessment of disease relapse. The isoperistaltic ileo-colonic anastomosis (IPICA) may improve post-surgical endoscopic follow up of CD patients.

Our aim was to compare safety, efficacy, recurrence rates and feasibility of ileo-colonoscopy (IC) between the two anastomotic configurations.

Methods Data on all consecutive CD patients aged≥18 years at a single tertiary center, who underwent ileo-colonic resection from 1/4/10 to 31/3/22, were collected retrospectively. Patients with anastomotic types other than APICA and IPICA and lack of IC within 18 months from surgery, were excluded.

Results A total of 143 patients were included [82 males (57.3%), age 38.2±14.3 years, disease duration 10.1±9.5 years]. Twenty-six patients (18.5%) underwent IPICA and 117 patients (81.8%) APICA surgery. Patients did not differ in age, gender, BMI, smoking status, biologic treatment exposure and disease duration at time of surgery (p=NS). Duration of surgery was significantly longer for IPICA than APICA (295.4±70.2 min vs 249.3±60.6 min, p<0.001, respectively). Rates of laparoscopic, lap-to-open and open procedures differed (57.7%, 30.8% and 11.5% for IPICA vs. 40.2%, 13.7% and 46.2%, for APICA, respectively; p=0.003). Hospitalisation duration and post-surgical complications (Clavien-Dindo classification) were comparable (p=NS). Fifteen patients were re-admitted with post-surgical complications within 90 days (1/26 (3.8%) in IPICA vs 14/117 (12.0%) in APICA group, p=0.124). At post-surgical IC, clinically significant anastomotic disease recurrence (Rutgeerts score≥2b) was observed in 38.5% of IPICA vs 34.2% of APICA, (p=0.820). Excluding patients with stricture at anastomosis (Ri=4s), no failure of small bowel (SB) intubation was observed in IPICA vs 11 patients (10.5%) in APICA group, yet statistical significance was not met (p=0.216). SB intubation time (defined as time from first image of anastomosis to first image of SB) was significantly shorter for IPICA (1.2±0.9 min) vs APICA (3.0±3.0 min, p<0.001).

Conclusions IPICA and APICA are comparable in procedural safety, anastomotic disease recurrence and rate of re-admissions. IPICA necessitates longer surgery time yet allows for significantly easier SB intubation with no intubation failure.

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Artikel online veröffentlicht:
15. April 2024