Wide-lumen stapled anastomosis vs. conventional end-to-end anastomosis in the treatment of Crohn's disease

PURPOSE: Preanastomotic recurrence and stricturing after surgery for ileoco lic Crohn's disease is a frequent, unexplained phenomena that may lead to p rompt reoperation. The aim of this study was to determine whether a wide-lu men stapled anastomosis (side-to-side, functional end-to-end) provides bett er outcome than a conventional sutured end-to-end anastomosis METHOD: A cas e-control comparative analysis of patients with Crohn's disease from two in flammatory bowel disease centers treated with wide-lumen stapled anastomosi s and a matched (age and gender) group treated with conventional sutured en d-to-end anastomosis was performed. RESULTS: A total of 138 patients with C rohn's disease were treated, 69 with wide-lumen stapled anastomosis and 69 with conventional sutured end-to-end anastomosis. Preoperative therapy, num ber of previous resections, indication for operation, and length of bowel r esected were similar in both groups. Fewer complications occurred after wid e-lumen stapled anastomosis (P = 0.048). A total of 55 patients developed r ecurrent Crohn's disease symptoms, 39 (57 percent) in the conventional sutu red end-to-end anastomosis and 16 (24 percent) in the wide-lumen stapled an astomosis group. Median follow-up was 70 and 46 months, respectively. After conventional sutured end-to-end anastomosis 18 reoperations were required, 15 for anastomotic stricture and 3 for fistulization. After wide-lumen sta pled anastomosis three reoperations were necessary, two for stricture and o ne for fistulization. The cumulative reoperation rate for anastomotic recur rence was significantly lower (P = 0.017; log-rank test) for the wide-lumen stapled anastomosis group. CONCLUSION: Wide-lumen stapled anastomosis is a s safe as conventional sutured end-to-end anastomosis and results in a lowe r incidence of symptomatic recurrent Crohn's disease and need for reoperati on. Further prospective study of the wide-lumen stapled anastomosis techniq ue is necessary to define the precise role of this operation in patients wi th Crohn's disease.