EP134 - Intracorporeal Anastomoses Are Associated With Improved Outcomes In Right-sided Resection For Individuals With Crohn’s Disease When Compared To Extracorporeal Anastomoses

ePoster Presenter(s)

• LN

  Lily Nguyen, MD

  Resident
  University of California Irvine
  Tustin, California, United States

  Disclosure information not submitted.

Author(s)

• RS

  Richard Straker

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

  Joseph Carmichael, MD

  Chief Medical Officer and Clinical Professor of Surgery
  University of California, Irvine
  Orange, CA, US

  Disclosure information not submitted.
• SM

  Steven Mills, MD

  Professor, Program Director
  UC Irvine
  Orange, California, United States

  Disclosure information not submitted.
• MW

  Matthew Whealon, MD

  Colorectal Surgeon
  University of California, Irvine
  Orange, California, United States

  Disclosure information not submitted.
• SS

  Skandan Shanmugan, MD (he/him/his)

  Associate Professor / Chief, Division of Colon & Rectal Surgery
  UC Irvine
  Irvine, CA, United States

  Disclosure information not submitted.
• 

  Michael J. Stamos, MD (he/him/his)

  Dean, School of Medicine
  University of California, Irvine
  University of California Irvine
  Irvine, CA, 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)

• 

  Valery Vilchez Parra, MD (she/her/hers)

  Assistant Professor
  University of California Irvine
  University of California at Irvine
  Irvine, California, United States

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

Purpose/Background: Surgery remains an important therapy for medically refractory and complicated Crohn's disease. We aimed to assess outcomes for minimally invasive anastomoses in patients undergoing right-sided resections for Crohn's disease.

Methods/Interventions: A retrospective review was conducted at a single academic institution in Southern California to analyze adult patients with Crohn's disease undergoing minimally invasive right-sided resection from 2010 to 2024. Patients with intracorporeal anastomosis (ICA) were compared to those who had an extracorporeal anastomosis (ECA). Descriptive statistics, chi-square tests, multivariate logistic regression, and Firth's penalized logistic regression analysis were used to identify significant associations.

Results/Outcomes: Among 172 patients, 92 patients had an ICA. Both groups had similar demographics, preoperative imaging/colonoscopy findings, and prior surgical history. Compared to those with ECA, patients with ICA had lower blood loss (25 vs. 30 mL, p=0.003), fewer additional resections (12.0% vs. 25.0%, p=0.03), and a higher rate of Pfannenstiel extraction (78.3% vs. 26.3%, p=0.0001). There was no significant difference in operative time (169.5 vs. 159 minutes, p=0.86) when comparing ICA vs. ECA. Post-operatively, patients with ICA had lower incidence of anastomotic leak (0.0% vs. 3.8%, p=0.05), superficial surgical site infection (SSI) (1.1% vs. 8.8%, p=0.01), and deep SSI (0.0% vs. 7.5%, p=0.004). On multivariate analysis, the need for additional resection was the only factor associated with ECA (OR 3.08, CI 1.27-7.47, p=0.01). The only factor associated with any SSI was ECA (OR 19.88, CI 2.14-184.92, p=0.01).

Conclusion/Discussion: Intracorporeal anastomoses are associated with decreased incidence of complications such as anastomotic leak, superficial surgical site infection, and deep surgical site infection. This association with decreased SSI persists after adjusting for confounders. Intracorporeal anastomoses should be standard when technically feasible when compared to extracorporeal anastomoses in the setting of Crohn's ileocolic and right sided colonic disease.

Perioperative outcomes for adult patients with Crohn's disease undergoing minimally invasive right-sided resections
LOS = length of stay; SSI = surgical site infection
Trends of completed intracorporeal anastomoses when compared to total anastomoses completed by year