Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease

Marco Scarpa, Imerio Angriman, Michela Barollo, Lnio Polese, Cesare Ruffolo, Matteo Bertin, Davide F. D'Amico

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Background/Aims: Anastomotic recurrence after bowel resection is a major problem in Crohn's disease surgery. The aim of this study is to compare recurrence rate after stapled side-to-side ileo-colonic anastomosis to those after stapled end-to-side or hand-sewn side-to-side anastomosis to distinguish the role of suture technique and anastomotic configuration in the prevention of Crohn's disease recurrence. Methodology: Eighty-four consecutive patients who had undergone ileo-colonic resection for Crohn's disease were enrolled: 12 of them had stapled side-to-side anastomosis, 36 stapled end-to-side anastomosis and 36 hand-sewn side-to-side anastomosis. We evaluated duration of operation, first bowel movement after operation, postoperative hospital staying, post-operative surgical complications, clinical recurrence and reoperation rate. The statistical analysis was performed using Student's t-test and Fisher exact test. Cumulative recurrence rates were compared using F Cox test and Kaplan-Meier method. Results: No statistically significant difference between the three groups was observed in early post-operative follow up. The stapled side-to-side anastomosis group obtained a better symptom-free survival than the stapled end-to-side group (p=0.04). In the stapled and hand-sewn side-to-side groups reoperation rates were significantly lower than in the stapled end-to-side group (p=0.01 and p=0.05 respectively). Conclusions: All the three types of anastomosis were demonstrated to be equally safe in early post-operative outcome. A longer follow-up showed a significantly lower incidence of reoperation recurrence in the stapled and hand-sewn side-to-side anastomosis compared to the stapled end-to-side anastomosis group. This result may suggest the configuration of the anastomosis as the key point in the recurrence of anastomotic Crohn's disease.

Original languageEnglish
Pages (from-to)1053-1057
Number of pages5
JournalHepato-Gastroenterology
Volume51
Issue number58
Publication statusPublished - Jul 2004

Fingerprint

Crohn Disease
Hand
Recurrence
Reoperation
Suture Techniques
Kaplan-Meier Estimate
Students
Survival
Incidence

Keywords

  • Crohn's disease
  • Hand-sewn anastomosis
  • Recurrence
  • Stapled anastomosis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Scarpa, M., Angriman, I., Barollo, M., Polese, L., Ruffolo, C., Bertin, M., & D'Amico, D. F. (2004). Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease. Hepato-Gastroenterology, 51(58), 1053-1057.

Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease. / Scarpa, Marco; Angriman, Imerio; Barollo, Michela; Polese, Lnio; Ruffolo, Cesare; Bertin, Matteo; D'Amico, Davide F.

In: Hepato-Gastroenterology, Vol. 51, No. 58, 07.2004, p. 1053-1057.

Research output: Contribution to journalArticle

Scarpa, M, Angriman, I, Barollo, M, Polese, L, Ruffolo, C, Bertin, M & D'Amico, DF 2004, 'Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease', Hepato-Gastroenterology, vol. 51, no. 58, pp. 1053-1057.
Scarpa M, Angriman I, Barollo M, Polese L, Ruffolo C, Bertin M et al. Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease. Hepato-Gastroenterology. 2004 Jul;51(58):1053-1057.
Scarpa, Marco ; Angriman, Imerio ; Barollo, Michela ; Polese, Lnio ; Ruffolo, Cesare ; Bertin, Matteo ; D'Amico, Davide F. / Role of stapled and hand-sewn anastomoses in recurrence of Crohn's disease. In: Hepato-Gastroenterology. 2004 ; Vol. 51, No. 58. pp. 1053-1057.
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AU - Scarpa, Marco

AU - Angriman, Imerio

AU - Barollo, Michela

AU - Polese, Lnio

AU - Ruffolo, Cesare

AU - Bertin, Matteo

AU - D'Amico, Davide F.

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N2 - Background/Aims: Anastomotic recurrence after bowel resection is a major problem in Crohn's disease surgery. The aim of this study is to compare recurrence rate after stapled side-to-side ileo-colonic anastomosis to those after stapled end-to-side or hand-sewn side-to-side anastomosis to distinguish the role of suture technique and anastomotic configuration in the prevention of Crohn's disease recurrence. Methodology: Eighty-four consecutive patients who had undergone ileo-colonic resection for Crohn's disease were enrolled: 12 of them had stapled side-to-side anastomosis, 36 stapled end-to-side anastomosis and 36 hand-sewn side-to-side anastomosis. We evaluated duration of operation, first bowel movement after operation, postoperative hospital staying, post-operative surgical complications, clinical recurrence and reoperation rate. The statistical analysis was performed using Student's t-test and Fisher exact test. Cumulative recurrence rates were compared using F Cox test and Kaplan-Meier method. Results: No statistically significant difference between the three groups was observed in early post-operative follow up. The stapled side-to-side anastomosis group obtained a better symptom-free survival than the stapled end-to-side group (p=0.04). In the stapled and hand-sewn side-to-side groups reoperation rates were significantly lower than in the stapled end-to-side group (p=0.01 and p=0.05 respectively). Conclusions: All the three types of anastomosis were demonstrated to be equally safe in early post-operative outcome. A longer follow-up showed a significantly lower incidence of reoperation recurrence in the stapled and hand-sewn side-to-side anastomosis compared to the stapled end-to-side anastomosis group. This result may suggest the configuration of the anastomosis as the key point in the recurrence of anastomotic Crohn's disease.

AB - Background/Aims: Anastomotic recurrence after bowel resection is a major problem in Crohn's disease surgery. The aim of this study is to compare recurrence rate after stapled side-to-side ileo-colonic anastomosis to those after stapled end-to-side or hand-sewn side-to-side anastomosis to distinguish the role of suture technique and anastomotic configuration in the prevention of Crohn's disease recurrence. Methodology: Eighty-four consecutive patients who had undergone ileo-colonic resection for Crohn's disease were enrolled: 12 of them had stapled side-to-side anastomosis, 36 stapled end-to-side anastomosis and 36 hand-sewn side-to-side anastomosis. We evaluated duration of operation, first bowel movement after operation, postoperative hospital staying, post-operative surgical complications, clinical recurrence and reoperation rate. The statistical analysis was performed using Student's t-test and Fisher exact test. Cumulative recurrence rates were compared using F Cox test and Kaplan-Meier method. Results: No statistically significant difference between the three groups was observed in early post-operative follow up. The stapled side-to-side anastomosis group obtained a better symptom-free survival than the stapled end-to-side group (p=0.04). In the stapled and hand-sewn side-to-side groups reoperation rates were significantly lower than in the stapled end-to-side group (p=0.01 and p=0.05 respectively). Conclusions: All the three types of anastomosis were demonstrated to be equally safe in early post-operative outcome. A longer follow-up showed a significantly lower incidence of reoperation recurrence in the stapled and hand-sewn side-to-side anastomosis compared to the stapled end-to-side anastomosis group. This result may suggest the configuration of the anastomosis as the key point in the recurrence of anastomotic Crohn's disease.

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KW - Recurrence

KW - Stapled anastomosis

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