P3238 - Redefining an Old Paradigm Regarding Recurrence in Crohn’s Disease Surgery: Intracorporeal Versus Extracorporeal Anastomosis in Ileocecectomies
Nouran Keshk, MD, Richard Sassun, MD, Annaclara Sileo, MD, Nicolas Mckenna, MD, William Perry, MD, Kevin behm, MD, David Larson, MD, Sherief Shawki, MD Mayo Clinic, Rochester, MN Introduction: Minimal-invasive surgery (MIS) was proven beneficial in Crohn’s Disease (CD). Intracorporeal anastomosis (ICA) represents a further improvement as it is associated with decreased complications and shorter hospitalization. Extracorporeal anastomosis (ECA) is preferred to ICA as it allows haptic feedback of the bowel and mesentery, which is historically required for bowel resection in CD to minimize recurrences. Methods: Retrospective observational study from a single, high-volume center at Mayo Clinic. All patients between 2016 and 2022 with Crohn’s disease who underwent a MIS ileocecectomy were identified and divided into ICA and ECA groups. Exclusion criteria were open surgery, end ileostomies, follow-up< 1 month, and ileocecectomy not due to CD. Chi-squared tests were conducted to evaluate differences between cohorts. Categorical variables were reported as frequencies (percent), while continuous variables were reported as mean ± standard deviation (SD) or median [interquartile range] according to their distribution. Missing values were excluded from the descriptive analyses. The Chi-Squared or Fisher’s exact test for categorical variables and independent sample t-test or Mann–Whitney U test for continuous variables were used as appropriate for group comparison. Results were compared to the literature. Multivariate Cox regression analysis was performed to assess the impact of mesentery involvement on clinical recurrences. Results: 107 patients were included in the ICA group (44.9% male, mean age of 40.2 [±16.6] years), while 270 patients in the ECA group (46.7% male, mean age of 41.9 [±17.3] years). The ECA group revealed a higher overall complication rate (30.4% versus 15.9%, p-value=0.004). The median length of stay was significantly reduced in the ICA group (p-value< 0.001). The rate of endoscopic recurrences with a Rutgeerts score >2, clinical recurrence, and surgical recurrence were not statistically different between the two cohorts. On the multivariable analysis for endoscopic and clinical recurrences, the ICA/ECA approach was not significant. Discussion: ICA seems to be safe in ileocecectomies for CD. The complication rate and length of stay were reduced, while not affecting the endoscopic, clinical, and surgical recurrence rates. The MIS technology provides accurate visualization, and haptic feedback, which could be used as surrogates for the tactile evaluation intra-operatively.
Disclosures: Nouran Keshk indicated no relevant financial relationships. Richard Sassun indicated no relevant financial relationships. Annaclara Sileo indicated no relevant financial relationships. Nicolas Mckenna indicated no relevant financial relationships. William Perry indicated no relevant financial relationships. Kevin behm indicated no relevant financial relationships. David Larson indicated no relevant financial relationships. Sherief Shawki indicated no relevant financial relationships.
Nouran Keshk, MD, Richard Sassun, MD, Annaclara Sileo, MD, Nicolas Mckenna, MD, William Perry, MD, Kevin behm, MD, David Larson, MD, Sherief Shawki, MD. P3238 - Redefining an Old Paradigm Regarding Recurrence in Crohn’s Disease Surgery: Intracorporeal Versus Extracorporeal Anastomosis in Ileocecectomies, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
