EP425 - Outcomes Following Ileocolonic Resections in Chrohns Patients: A Comparative Analysis Based on Surgical Anastomotic Technique

Purpose/Background: Chrohns disease (CD) is a chronic, relapsing condition in which about 70% of patients require surgical intervention during their lifetime. Among those who experience postoperative disease recurrence, nearly 50% will require re-intervention within 10 years. Postoperative recurrence is evaluated endoscopically and clinically. Endoscopic recurrence (ePOR) is determined by the Rutgeerts Score, according to mucosal lesions at the anastomotic site on surveillance colonoscopy, whereas clinical recurrence refers to the reappearance of symptoms attributable to active disease.

While stapled side-to-side anastomosis remains the conventional surgical standard, alternative techniques such as the Kono-S hand-sewn anastomosis have been proposed with the aim of mitigating recurrence. Previous studies have yielded conflicting evidence regarding the benefit of Kono-S compared to traditional approaches. The primary objective of this study is to compare recurrence rates according to anastomotic technique at index operation and to assess potential differences in surgical outcomes among techniques.

Methods/Interventions: A retrospective review was conducted including patients who underwent ileocolic resection for CD at our institution between May 2021-Sept 2025. Demographic data, disease phenotype, operative details and follow-up were collected from electronic medical records. Patients were stratified according to the type of anastomosis performed at index operation: anti-peristaltic stapled(APS), isoperistaltic stapled(IPS), Kono-S(KS), or unspecified stapled(US). Inclusion criteria were CD patients >18 yrs old who underwent ileocolic resection with primary anastomosis. Exclusion criteria included resections performed without primary anastomosis and younger than 18 yrs. Primary outcomes included endoscopic and clinical recurrence. Secondary outcomes included 30-day mortality, readmission, ICU stay, anastomotic leak, postoperative complications (Clavien-Dindo), and length of stay. Descriptive statistics and exploratory analysis (Kruskal-Wallis rank sum test, Fischer's exact test) was performed to compare recurrence rates and perioperative outcomes among anastomotic techniques.

Results/Outcomes: A total of 61 patients met inclusion criteria (22-APS, 14-IPS, 17-KS, and 8-US). No 30-day mortalities occurred. All techniques demonstrated comparable rates of anastomotic leak, readmission, and recurrence. We found that APS, IPS, and KS were similar to each other in ICU stay, length of stay, and complication severity, but this differed significantly with the US group faring worse across all three categories (p < 0.001). When all stapled techniques were pooled, Kono-S patients had a shorter length of stay (3d vs 5d; p = 0.030). Recurrence was significantly associated with history of prior surgery (p < 0.001) and former smoking (p < 0.01), consistent with established risk factors.

Conclusion/Discussion: Our findings suggest that IPS and Kono-S anastomoses are safe with similar recurrence rates. Kono-S was associated with shorter hospitalization when compared with pooled stapled approaches. Baseline characteristics such as smoking and previous surgeries remain critical predictors of recurrence. These findings suggest that factors beyond anastomotic configuration may exert a greater influence on recurrence risk. Further prospective multi center studies are warranted to clarify the optimal anastomotic approach for minimizing disease recurrence and improving long term outcomes in CD.