EPD301 - A Comparison of Short-Term Outcomes Between Primary, Secondary, and Tertiary Ileocolic Resections

ePoster of Distinction Presenter(s)

• SC

  Sarah Cao, MD

  Resident
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Author(s)

• 

  Katherine W. Lam, MD

  Colorectal Surgery Research Fellow
  Icahn School of Medicine at Mount Sinai
  Westchester Medical Center
  New York, NY, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• SB

  Salam Bachour, MD, MS

  Fellow
  cahn School of Medicine at Mount Sinai, Division of Gastroenterology
  New York, New York, United States

  Disclosure information not submitted.
• BS

  Bruce E. Sands, MD, MS

  Chief, Division of Gastroenterology
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• MK

  Maia Kayal, MD, MS

  Associate Professor
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• SH

  Sue J. Hahn, MD

  Assistant Professor of Surgery
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.
• 

  Sergey Khaitov, MD

  Associate Professor of Surgery
  Icahn School of Medicine
  New York, New York, United States

  Disclosure information not submitted.
• AG

  Alexander J. Greenstein, MD

  Professor of Surgery
  Mount Sinai Hospital
  New York, New York, United States

  Disclosure information not submitted.
• 

  Patricia Sylla, MD, FACS, FASCRS (she/her/hers)

  System Chief of Colon and Rectal Surgery
  Mount Sinai Hospital
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no relevant financial relationships.

Senior Author(s)

• 

  Michael C. Plietz, MD (he/him/his)

  Assistant Professor of Surgery
  Icahn School of Medicine at Mount Sinai
  New York, New York, United States

  Disclosure information not submitted.

Purpose/Background: Repeat ileocolic resection (ICR) is a necessity in many Crohn's disease (CD) patients. While repeat ICR is associated with increased technical complexity, there is a paucity of data examining secondary and tertiary ICR results. The purpose of this study is to compare the surgical approach and outcomes of primary versus repeat ICR for CD.

Methods/Interventions: We conducted a retrospective review of ICRs performed 2018 to 2024 at a single tertiary inflammatory bowel disease (IBD) center from an IRB-approved prospective surgical IBD database. The cohort was divided into three groups based on the number of ICRs: primary, secondary, and tertiary. Categorical and continuous variables were compared between groups. Multivariate logistic regression was performed utilizing patient and surgical factors including number of ICRs to examine the impact on 30-day complications, reoperations, readmissions, stoma creation, and conversion from laparoscopy.

Results/Outcomes: 821 ICR procedures were identified with 619 (76.3%) primary, 151 (18.6%) secondary, and 41 (5.0%) tertiary ICRs. Repeat ICR patients were older with a longer duration of CD and higher rates of recent steroid usage. They were more likely to present with obstruction and less likely to have fistulizing disease or abscess (obstruction: 52.2 vs 68.2 vs 78.0%, p< 0.001; fistulization: 39.3 vs 27.2 vs 26.8%, p=0.009; abscess: 36.7 vs 23.2 vs 17.1%, p< 0.001).

The overall complication rate was 19.0%, with higher rates among repeat ICRs than primary ICRs on univariate analysis (16.3 vs 27.2 vs 26.8%, p=0.001). However, on multivariate analysis, repeat ICR did not have a significant impact on complication rates. Females had lower odds (OR 0.57[0.38 - 0.85], p=0.006) and those who had prior abdominal surgeries had higher odds of complication (OR 1.67[1.01-2.75], p=0.046). Anastomotic leak rates did not differ (1.0 vs 0.7 vs 2.4%, p=0.10). While on univariate analysis, readmission rates differed between primary and repeat ICRs (5.2 vs 10.6 vs 12.2%, p = 0.02), this was not demonstrated on multivariate analysis. Nonelective ICRs had higher odds of readmission (OR 2.09[1.08-4.10], p=0.03). Repeat ICR had no impact on reoperation on univariate or multivariate analysis.

Rates of ostomy creation were 6.6, 9.3, and 0% respectively. Repeat ICR did not affect diversion rates on univariate or multivariate analysis. Patients who required more extensive operations than ICR alone (OR 3.51[1.65-7.8], p=0.001) or had an abscess present (OR 3.87[1.9-8.17], p< 0.001] had higher odds of diversion. Primary ICRs were more likely to be completed laparoscopically (78.4 vs 64.2 vs 48.8%, p< 0.001), while repeat ICRs were more likely to be approached open (6.1 vs 18.5 vs 34.1%). Conversion rates were similar between groups (15.5 vs 17.2 vs 17.1%, p=0.09). On multivariate regression, number of ICRs did not impact conversion among cases begun laparoscopically. Older age, nonelective surgery, preoperative steroids use, presence of abscess, and additional procedures increased odds of conversion.

Conclusion/Discussion: In this comparison of primary and repeat ICRs, there was no statistical impact of repeat ICR on short-term complications, readmissions, reoperations, diversion, or conversion. While surgical approach differed between groups, a significant portion of repeat ICRs were completed successfully laparoscopically. Overall, this study demonstrates that repeat laparoscopic ICR without diversion is feasible and safe when performed at an experienced high-volume center.

Table 1: Demographics and surgical characteristics
Table 2: Summary of surgical outcomes