QS129 - Recurrence of Ileocolonic Crohn's Disease in the Modern Era: Does the Type of Anastomosis Matter?

Sunday, May 11, 2025

2:57 PM – 3:00 PM PT

Location: Room 9, Upper Level

Quick Shot Presenter(s)

Montserrat Tijerina, BA (she/her/hers)

Medical Student
Pritzker School of Medicine
Chicago, IL, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Senior Author(s)

Kinga S. Olortegui, MD, MS, FACS

Assistant Professor
UChicago Medicine
Chicago, Illinois, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Martin Uwah, M.D. (he/him/his)

Assistant Professor of Surgery
University of Chicago Medicine
University of Chicago
Chicago, Illinois, United States

Disclosure information not submitted.
KU

Konstantin Umanskiy, MD

Professor of Surgery
University of Chicago
Chicago, Illinois, United States

Disclosure information not submitted.
Virginia O. Shaffer, MD

Professor, Chief of Colorectal Surgery
University of Chicago
Chicago, Illinois, United States

All of the relevant financial relationships listed below have been mitigated.
Davol Inc: Honoraria (Terminated, August 12, 2023); Intuitive Surgical Inc: Honoraria (Ongoing)
Benjamin D. Shogan, MD (he/him/his)

Associate Professor of Surgery
University of Chicago
University of Chicago
Chicago, Illinois, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
RH

Roger Hurst, MD

Professor of Surgery
University of Chicago Medicine
Chicago, Illinois, United States

Disclosure information not submitted.
RN

Rachel Nordgren, PhD

Biostatistician
University of Chicago, Department of Public Health Sciences
Chicago, Illinois, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Montserrat Tijerina, n/a: This individual has no financial relationships with ineligible companies.

Kinga S. Olortegui, MD, MS, FACS: This individual has no financial relationships with ineligible companies.

Virginia O. Shaffer, MD: Davol Inc: Honoraria (Terminated, August 12, 2023); Intuitive Surgical Inc: Honoraria (Ongoing)

Benjamin D. Shogan, MD: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Recurrence of Crohn’s disease impacts the quality of life for individuals who undergo resection of their disease. The superiority of outcomes for distinct anastomotic methods has recently become a topic of interest. At our hospital, we have a convenience sample of surgeons who utilize a wide variety of techniques, including routine use of handsewn versus stapled anastomoses, as well as various configurations (end-to-end, side-to-side, end-to-side, side-to-end and Kono-S). Our study aims to identify differences in recurrence between the anastomotic techniques and which, if any, factors significantly impact outcomes. We hypothesize that there will be no difference in anastomotic complications and recurrence when comparing post-operative outcomes for handsewn versus stapled techniques, as well as the various configurations used.

Methods/Interventions: We conducted a retrospective chart review of adult patients with Crohn’s disease who underwent ileocecal resection in both the elective and non-elective setting at the University of Chicago Medical Center between January 1, 2018 and December 31, 2022. We collected patient characteristics, preoperative and intraoperative outcomes, and post-surgical results. Statistical analyses were used to describe any significant differences in outcomes for patients who received an ileocecal anastomosis using the various anastomotic techniques.

Results/Outcomes: A total of 239 patients (43% male) were included. The mean age was 40.9 years. Mean BMI was 25.2. 12.1% of patients were smoking at the time of surgery. 28% were treated with systemic steroids, and 78% were treated with biologic therapies leading up to surgery. 84% of patients underwent surgery on an elective basis. 124 (51.9%) received a handsewn anastomosis. Configurations included side-to-side (42%), end-to-end (29%, end-to-side (1%) and Kono-S (1%). Four patients (2%) experienced an anastomotic leak, and anastomotic configuration was not associated with leak (p=0.996), nor was stapling versus handsewing (p=0.819). Patients treated with biologics pre-operatively were less likely to experience an anastomotic leak (p=0.033). After a mean of 32 months of follow up (IQR 19-54 months), 63 experienced known recurrence of their Crohn’s disease (clinical or endoscopic with Rutgeert’s score > i2a). Anastomotic configuration was not associated with recurrence (p=0.597). Smoking was associated with Crohn’s recurrence (p=0.026), as was urgent/emergency surgery (p=0.002).

Conclusion/Discussion: Our study shows a low rate of surgical recurrence and complications in a modern sample of patients who underwent surgery for ileocecal Crohn’s disease. Analysis demonstrated no association between post-operative outcomes and anastomotic configurations. In summary, this study supports the use of any configuration of an ileocolonic anastomosis for the treatment of ileocecal Crohn's disease. In our cohort, pre-operative use of biologics appeared to be protective against anastomotic complications.