The following is a summary of “Anastomotic Configuration and Temporary Diverting Ileostomy Do Not Increase Risk of Anastomotic Stricture in Postoperative Crohn’s Disease,” published in the December 2023 issue of Gastroenterology by Bachour, et al.

The surgical management of Crohn’s disease (CD) often involves ileocolonic resection (ICR), which can be complicated by anastomotic stricturing (AS). The natural history and risk factors contributing to AS remain to be determined.

For a retrospective cohort study, researchers examined CD patients who underwent ICR and had at least one postoperative ileocolonoscopy between 2009 and 2020. Ileocolonoscopies and corresponding imaging were assessed for AS without neoterminal ileal extension. AS severity, time to detection, and endoscopic interventions were documented. The primary outcome was AS development; the secondary outcome was the time to AS detection.

Among 602 adult CD patients with ICR, 426 had primary anastomosis, and 136 had temporary diversion. The anastomotic configurations were side-to-side (308), end-to-side (148), and end-to-end (136). AS developed in 18.3% of patients, with a median time of 3.2 years to detection. The severity of AS at detection correlated with the need for repeat surgical resection. Multivariable analysis showed that anastomotic configuration and temporary diversion were not associated with AS risk or time to AS. Preoperative stricturing disease was linked to a decreased time to AS (adjusted hazard ratio 1.8; P = 0.049). Endoscopic ileal recurrence before AS was not associated with subsequent AS detection.

AS is a relatively common complication after CD surgery. Patients with a history of stricturing disease behavior are at a heightened risk of AS. Anastomotic configuration, temporary diversion, and ileal CD recurrence do not elevate the risk of AS. Early detection and intervention for AS may be crucial in preventing progression to repeat ICR.

Source: journals.lww.com/ajg/abstract/2023/12000/anastomotic_configuration_and_temporary_diverting.24.aspx