Surgical and non-surgical risk factors affecting the insufficiency of ileocolic anastomosis after first-time surgery in Crohn’s disease patients  

作　　者：Jaroslaw Cwaliński Filip Lorek Łukasz Mazurkiewicz MichałMazurkiewicz Wojciech Lizurej Jacek Paszkowski Hanna Cholerzyńska Wiktoria Zasada 

机构地区：[1]Department of General,Endocrinological Surgery and Gastroenterological Oncology,Poznan University of Medical Sciences,Poznan 60-355,Poland

出　　处：《World Journal of Gastrointestinal Surgery》2024年第10期3253-3260,共8页世界胃肠外科杂志（英文）

摘　　要：BACKGROUND Crohn's disease(CD)often necessitates surgical intervention,particularly when it manifests in the terminal ileum and ileocecal valve.Despite undergoing radical surgery,a subset of patients experiences recurrent inflammation at the anasto-motic site,necessitating further medical attention.AIM To investigate the risk factors associated with anastomotic insufficiency following ileocecal resection in CD patients.METHODS This study enrolled 77 patients who underwent open ileocolic resection with pri-mary stapled anastomosis.Patients were stratified into two groups:Group I co-mprised individuals without anastomotic insufficiency,while Group II included patients exhibiting advanced anastomotic destruction observed endoscopically or those requiring additional surgery during the follow-up period.Surgical and non-surgical factors potentially influencing anastomotic failure were evaluated in both cohorts.RESULTS Anastomotic insufficiency was detected in 12 patients(15.6%),with a mean time interval of 30 months between the initial surgery and recurrence.The predomi-nant reasons for re-intervention included stenosis and excessive perianastomotic lesions.Factors associated with a heightened risk of anastomotic failure encompassed prolonged postoperative obstruction,anastomotic bleeding,and clinically confirmed micro-leakage.Additionally,patients in Group II exhibited preoperative malnutrition and early recurrence of symptoms related to CD.CONCLUSION Successful surgical outcomes hinge on the attainment of a fully functional anastomosis,optimal metabolic status,and clinical remission of the underlying disease.Vigilant endoscopic surveillance following primary resection facilitates the timely identification of anastomotic failure,thereby enabling noninvasive interventions.

关 键 词：Crohn’s disease Ileocolic resection Anastomotic insufficiency Endoscopic surveillance SURGERY Risk factors 

分 类 号：R656.7[医药卫生—外科学]