P557 Long-term outcomes following laparoscopic ileocecal resection without any residual lesion for Crohn’s disease: a single-center observational study

Background To describe the characteristic of Crohn’s disease (CD) patients undergoing ileocecal resection, and to analyze the long-term outcomes following surgery. Methods A retrospective study on patients undergoing ileocecal resection without any from residual disease in the remnant intestine from July 2011 to March 2020 was conducted. The clinical data and the following outcomes were evaluated. Results Among 86 CD patients, the mean disease duration was 33.4 months, 40 patients had perianal fistula. 53 patients underwent surgery due to stricture, 26 was perforation, and 7 was failure of medical therapy. 27 (31.4%) patients suffered postoperative complications. Mean follow-up was 44.4 months, 47 (54.7%) patients had an endoscopic recurrence with 9 were non-anastomotic recurrence, 20 were anastomotic recurrence, and 18 were both anastomotic and non-anastomotic recurrence, and 4 patients had a surgical recurrence. Furthermore, 41 (47.7%) had postoperative prophylaxis with 22 (25.6%) azathioprine and 17 (19.8%) infliximab. 45 (52.3%) patients were without postoperative prophylaxis, 19 (42.2%) had an endoscopic recurrence, and 26 (57.8%) had none endoscopic recurrence. The penetrating disease and lower skeletal muscle index were independent risk factors for endoscopic recurrence. Conclusion CD patients with penetrating disease or lower skeletal muscle index were suggested to have earlier postoperative prophylaxis after ileocecal resection without any from residual disease in the remnant intestine.

Experiences with the Kono-S anastomosis in Crohn’s disease of the terminal ileum—a cohort study

Purpose The most frequent long-term complication after ileocecal resection in Crohn’s disease is anastomotic recurrence and subsequent stenosis. Recurrence typically begins at the site of the anastomosis, raising the question of whether the surgical technique of the anastomosis could affect recurrence rates. Kono-S anastomosis is a hand-sewn antimesenteric functional end-to-end anastomosis that offers a wide lumen that is well accessible for endoscopic dilatation. The purpose of our study is to review the rate of postoperative complications almost 2 years after the introduction of this technique. Materials and methods This is a prospective single-center cohort study of all consecutive patients with Crohn’s disease undergoing ileocecal resection. Patients’ characteristics as well as specific data for the surgical procedure and short-term outcome were evaluated. Results Thirty patients were operated for Crohn’s disease of the terminal ileum (n = 24) or anastomotic recurrence (n = 6). Postoperative complications with a Clavien-Dindo Score ≥ IIIb were observed in three patients. One patient showed a hemorrhage and underwent surgical hemostasis. Two patients developed anastomotic leakage; in both cases, ileostomy was created after resection of the anastomosis. The median hospital stay was 9 days (IQR 7–12). A comparison with a historic group of conventionally operated patients of our hospital revealed no differences in short-term results except for the duration of surgery. Conclusion The Kono-S anastomosis is associated with acceptable short-term results, complications, and recurrence rates comparable with the established anastomotic techniques. Longer operation times are observed, but the few published studies concerning long-term recurrence are promising.