Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Ileocecal Anastomosis Type Significantly Influences Long-Term Functional Status, Quality of Life, and Healthcare Utilization in Postoperative Crohn's Disease Patients Independent of Inflammation Recurrence

Gajendran, Mahesh, MD, MPH1; Bauer, Anthony J, PhD2,3,4; Buchholz, Bettina M, MD, PhD2; Watson, Andrew R, MD5; Koutroubakis, Ioannis E, MD, PhD2; Hashash, Jana G, MD, MSc2; Ramos-Rivers, Claudia, MD2; Shah, Nilesh, PhD6; Lee, Kenneth K, MD7; Cruz, Ruy J, MD, PhD8; Regueiro, Miguel, MD2; Zuckerbraun, Brian, MD9; Schwartz, Marc, MD2; Swoger, Jason, MD2; Barrie, Arthur, MD, PhD2; Harrison, Janet, MD2; Hartman, Douglas J, MD10; Salgado, Javier, MD5; Rivers, William M, RN2; Click, Benjamin, MD2; Anderson, Alyce M, PhD2; Umapathy, Chandraprakash, MD, MS1; Babichenko, Dmitriy11; Dunn, Michael A, MD2; Binion, David G, MD2

American Journal of Gastroenterology: April 2018 - Volume 113 - Issue 4 - p 576–583
doi: 10.1038/ajg.2018.13
ORIGINAL CONTRIBUTIONS: INFLAMMATORY BOWEL DISEASE
Buy
SDC

OBJECTIVES: Anastomotic reconstruction following intestinal resection in Crohn's disease (CD) may employ side-to-side anastomosis (STSA; anti-peristaltic orientation) or end-to-end anastomosis (ETEA). Our aim was to determine the impact of these two anastomotic techniques on long-term clinical status in postoperative CD patients.

METHODS: We performed a comparative effectiveness study of prospectively collected observational data from consented CD patients undergoing their first or second ileocolonic bowel resection and re-anastomosis between 2008 and 2012, in order to assess the association between anastomosis type and 2-year postoperative quality of life (QoL), healthcare utilization, disease clinical or endoscopic recurrence, use of medications, and need for repeat resection.

RESULTS: One hundred and twenty eight postoperative CD patients (60 STSA and 68 ETEA) were evaluated. At 2 years postoperatively, STSA patients had higher rates of emergency department visits (33.3% vs. 14.7%;P=0.01), hospitalizations (30% vs. 11.8%;P=0.01), and abdominal computed tomography scans (50% vs. 13.2%;P<0.001) with lower QoL (mean short inflammatory bowel disease questionnaire 47.9 vs. 53.4;P=0.007). There was no difference among the two groups in the 30 day surgical complications and 2-year patterns of disease activity, CD medication requirement, endoscopic recurrence, and need for new surgical management (allP > 0.05).

CONCLUSIONS: At 2 years postoperatively, CD patients with ETEA demonstrated better QoL and less healthcare utilization compared with STSA, despite having similar patterns of disease recurrence and CD treatment. These findings suggest that surgical reconstruction of the bowel as an intact tube (ETEA) contribute to improved functional and clinical status in patients with CD.

1Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

2Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

3Department of Physiology, Liberty University Medical School, Lynchburg, Virginia, USA

4Department of Surgery, University Bonn Medical School, Bonn, Germany

5Division of Colorectal Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

6Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

7Division of Gastrointestinal Surgical Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

8Starzl Transplant Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

9Division of Trauma and Acute Care Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

10University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA

11School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

Correspondence: Dr David G. Binion, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA. E-mail: binion@pitt.edu

published online 6 March 2018

SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/A234

Received 3 October 2016; accepted 18 December 2017

© The American College of Gastroenterology 2018. All Rights Reserved.
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website