PURPOSE: This study attempts to determine whether stapled side-to-side anastomosis, compared with handsewn end-to-end anastomosis, results in decreased recurrence of Crohn's disease following ileocolic resection.
METHODS: Patients with Crohn's disease who underwent an ileocolic resection were randomized to side-to-side anastomosis or end-to-end anastomosis. Colonoscopy was performed at 12 months. The primary outcome was endoscopic recurrence, while the secondary outcome was symptomatic recurrence (defined as symptoms attributable to Crohn's disease and severe enough to warrant treatment, plus endoscopic disease recurrence).
RESULTS: One hundred and thirty-nine subjects were included in the efficacy analysis. After a mean follow-up of 11.9 months, the endoscopic recurrence rate was 42.5 percent in the end-to-end anastomosis group, compared with 37.9 percent in the side-to-side anastomosis group (-4.6 percent difference; 95 percent confidence interval -21.0 to 11.9 percent; P = 0.55). The symptomatic recurrence rate was 21.9 percent in the end-to-end anastomosis group, compared with 22.7 percent in the side-to-side anastomosis group (+0.8 percent difference; 95 percent confidence interval -13.2 to 15.3 percent; P = 0.92). In multivariate logistic regression analysis, previous resections were predictive of a higher risk of both endoscopic (odds ratio 1.78; 95 percent confidence interval 1.06 to 2.90; P = 0.028) and symptomatic (odds ratio 2.0; 95 percent confidence interval 1.14 to 3.60; P = 0.0016) recurrence. Compliance with postoperative maintenance therapy was predictive of a lower risk of symptomatic recurrence (odds ratio 0.13, 95 percent confidence interval 0.01 to 0.78; P = 0.021).
CONCLUSION: Recurrence rates are similar whether end-to-end anastomosis or side-to-side anastomosis is performed.
1 Department of Surgery, University of Toronto, Toronto, Ontario, Canada
2 Department of Health Policy Management and Administration, University of Toronto, Toronto, Ontario, Canada
3 Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
4 Department of Surgery, Mayo Clinic, Rochester, Minnesota
5 Department of Surgery, University of Calgary, Calgary, Alberta, Canada
Funded by the Canadian Institute for Health Research, the Crohn's and Colitis Foundation of America, and Ethicon Endosurgery.
Presented at the American Gastroenterology Association Meeting, Washington, D.C., May 20 to 23, 2007.
Address of correspondence: Robin S. McLeod, M.D., Room 449, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada. E-mail: firstname.lastname@example.org