BACKGROUND: Rates of postoperative complications are particularly high among patients with Crohn's disease. OBJECTIVE: The aim of this study was to assess whether positive inflammatory histological margins, among other factors, pose a risk for intra-abdominal septic complications in patients with Crohn's disease undergoing ileocolic resection. DESIGN: A retrospective study of patient records, during 2000-2010, was conducted. SETTINGS: This investigation was performed at a single medical center. PATIENTS: Included were 166 individuals with Crohn's disease (85 males, mean age 35.6). INTERVENTION: Ileocolic resection with primary anastomosis was performed. MAIN OUTCOME MEASURE: The primary outcomes measured were postoperative intra-abdominal septic complications. RESULTS: Twenty-five patients (15%) developed intra-abdominal septic complications, including anastomotic leak, intra-abdominal abscesses and collections, and enterocutaneous fistulas. There were no postoperative deaths. Univariate analysis revealed that a long course of disease before surgery, an emergency surgery, steroid treatment of more than 3 months before surgery, additional sigmoidectomy, and positive surgical margins detected on histopathological examination were associated with intra-abdominal septic complications. In a multivariate analysis, only disease duration longer than 10 years (OR 4.575 (CI 1.592-13.142), p = 0.005), additional sigmoidectomy (OR 5.768 (CI 1.088-30.568), p = 0.04), and positive histological resection margins (OR 2.996 (CI 1.085-8.277), p = 0.03) were found to be independent risk factors. LIMITATIONS: This study was limited by the incomplete data regarding preoperative albumin levels. CONCLUSIONS: Positive histological margins, disease duration of more than 10 years, and added sigmoidectomy are independent risk factors that are associated with postoperative intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. These risk factors should be considered when the need for a diverting stoma is questionable. A frozen section of the margins may assist in the decision as to a temporary ileostomy construction.
BACKGROUND: Rates of postoperative complications are particularly high among patients with Crohn's disease. OBJECTIVE: The aim of this study was to assess whether positive inflammatory histological margins, among other factors, pose a risk for intra-abdominal septic complications in patients with Crohn's disease undergoing ileocolic resection. DESIGN: A retrospective study of patient records, during 2000-2010, was conducted. SETTINGS: This investigation was performed at a single medical center. PATIENTS: Included were 166 individuals with Crohn's disease (85 males, mean age 35.6). INTERVENTION: Ileocolic resection with primary anastomosis was performed. MAIN OUTCOME MEASURE: The primary outcomes measured were postoperative intra-abdominal septic complications. RESULTS: Twenty-five patients (15%) developed intra-abdominal septic complications, including anastomotic leak, intra-abdominal abscesses and collections, and enterocutaneous fistulas. There were no postoperative deaths. Univariate analysis revealed that a long course of disease before surgery, an emergency surgery, steroid treatment of more than 3 months before surgery, additional sigmoidectomy, and positive surgical margins detected on histopathological examination were associated with intra-abdominal septic complications. In a multivariate analysis, only disease duration longer than 10 years (OR 4.575 (CI 1.592-13.142), p = 0.005), additional sigmoidectomy (OR 5.768 (CI 1.088-30.568), p = 0.04), and positive histological resection margins (OR 2.996 (CI 1.085-8.277), p = 0.03) were found to be independent risk factors. LIMITATIONS: This study was limited by the incomplete data regarding preoperative albumin levels. CONCLUSIONS: Positive histological margins, disease duration of more than 10 years, and added sigmoidectomy are independent risk factors that are associated with postoperative intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. These risk factors should be considered when the need for a diverting stoma is questionable. A frozen section of the margins may assist in the decision as to a temporary ileostomy construction.
Authors: Kamal V Patel; Amir A Darakhshan; Nyree Griffin; Andrew B Williams; Jeremy D Sanderson; Peter M Irving Journal: Nat Rev Gastroenterol Hepatol Date: 2016-10-26 Impact factor: 46.802
Authors: James Wt Toh; Peter Stewart; Matthew Jfx Rickard; Rupert Leong; Nelson Wang; Christopher J Young Journal: World J Gastroenterol Date: 2016-10-28 Impact factor: 5.742
Authors: Christian Schineis; Andrea Ullrich; Kai S Lehmann; Christoph Holmer; Johannes C Lauscher; Benjamin Weixler; Martin E Kreis; Claudia Seifarth Journal: PLoS One Date: 2021-03-04 Impact factor: 3.240