What Is the Risk of Anastomotic Leak After Repeat Intestinal Resection in Patients With Crohn's Disease?

Johnston WF1, Stafford C, Francone TD, Read TE, Marcello PW, Roberts PL, Ricciardi R. Dis Colon Rectum. 2017 Dec;60(12):1299-1306. doi: 10.1097/DCR.0000000000000946.
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1 Department of Colon and Rectal Surgery, Lahey Hospital & Medical Center, Burlington, Massachusetts.


BACKGROUND: Approximately half of Crohn's patients require intestinal resection, and many need repeat resections.

OBJECTIVE: The purpose of this study was to evaluate the increased risk of clinical anastomotic leak in patients with a history of previous intestinal resection undergoing repeat resection with anastomosis for Crohn's disease.

DESIGN: This was a retrospective analysis of prospectively collected departmental data with 100% capture.

SETTINGS: The study was conducted at the department of colorectal surgery in a tertiary care teaching hospital between July 2007 and March 2016.

PATIENTS: A cohort of consecutive patients with Crohn's disease who were treated with intestinal resection and anastomosis, excluding patients with proximal fecal diversion, were included. The cohort was divided into 2 groups, those with no previous resection compared with those with previous resection.

MAIN OUTCOME MEASURES: Clinical anastomotic leak within 30 days of surgery was measured.

RESULTS: Of the 206 patients who met criteria, 83 patients had previous intestinal resection (40%). The 2 groups were similar in terms of patient factors, immune-suppressing medication use, and procedural factors. Overall, 20 clinical anastomotic leaks were identified (10% leak rate). There were 6 leaks (5%) detected in patients with no previous intestinal resection and 14 leaks (17%) detected in patients with a history of previous intestinal resection (p < 0.005). The OR of anastomotic leak in patients with Crohn's disease with previous resection compared with no previous resection was 3.5 (95% CI, 1.3-9.4). Patients with 1 previous resection (n = 53) had a leak rate of 13%, whereas patients with ≥2 previous resections (n = 30) had a leak rate of 23%. The number of previous resections correlated with increasing risk for clinical anastomotic leak (correlation coefficient = 0.998).

LIMITATIONS: This was a retrospective study with limited data to perform a multivariate analysis.

CONCLUSIONS: Repeat intestinal resection in patients with Crohn's disease is associated with an increased rate of anastomotic leakage when compared with initial resection despite similar patient, medication, and procedural factors. See Video Abstract at http://links.lww.com/DCR/A459.

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