Construction of an ileocolic neosphincter - Nipple valve anastomosis for prevention of postoperative recurrence of Crohn's disease in the neoterminal ileum after ileocecal or ileocolic resection. A long-term follow-up study.

OBJECTIVE: To test the effect of an ileocolic neosphincter-nipple valve anastomosis after ileocolic resection for Crohn's disease, on the clinical and surgical recurrence-free survival, in a long-term follow-up pilot study. BACKGROUND AND AIMS: Fifty-nine patients, with Crohn's disease were operated on with an ileocecal or ileocolic resection and a nipple valve between 1993 and 2007.
METHODS: The nipple valve is constructed by everting the neoterminal ileum for a length of 4-5 cm and stabilized with 3 or 4 longitudinal stapler rows (N=36) or only in a basal zone (N=23). The nipple is telescoped with the tip pointed into the colon and the base of the nipple anastomosed to colon. Follow-up at regular intervals included clinical evaluation, Harvey-Bradshaw index, laboratory tests, colonoscopy and small bowel radiology when appropriate.
RESULTS: The perioperative mortality was nil. Early postoperative complications were: wound infection (N=4), anastomotic leak (N=1), reoperated, nipple ischemia (N=1) reoperated, enterocutaneous fistula (N=1). Clinical recurrence in the neoterminal ileum was after 1, 3, 4 and 5 years: 11%, 20%, 23% and 24%. Eleven patients (19%) were reoperated for recurrence in the neoterminal ileum after median 96 months follow-up. The cumulative reoperation rate was after 1, 3, 4 and 5 years: 4%, 13%, 13% and 16%, respectively.
CONCLUSION: The low clinical and surgical recurrence rate in the neoterminal ileum may suggest a protective effect of the neosphincter on postoperative recurrence of Crohn's disease. This result should be tested in a randomized controlled trial.