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. 2021 Mar 4;16(3):e0247796.
doi: 10.1371/journal.pone.0247796. eCollection 2021.

Microscopic inflammation in ileocecal specimen does not correspond to a higher anastomotic leakage rate after ileocecal resection in Crohn's disease

Christian Schineis  1 , Andrea Ullrich  2 , Kai S Lehmann  1 , Christoph Holmer  3 , Johannes C Lauscher  1 , Benjamin Weixler  1 , Martin E Kreis  1 , Claudia Seifarth  1
Affiliations

Microscopic inflammation in ileocecal specimen does not correspond to a higher anastomotic leakage rate after ileocecal resection in Crohn's disease

Christian Schineis et al. PLoS One. .

Abstract

Background: Patients with Crohn's disease suffer from a higher rate of anastomotic leakages after ileocecal resection than patients without Crohn's disease. Our hypothesis was that microscopic inflammation at the resection margins of ileocecal resections in Crohn's disease increases the rate of anastomotic leakages.

Patients and methods: In a retrospective cohort study, 130 patients with Crohn's disease that underwent ileocecal resection between 2015 and 2019, were analyzed. Anastomotic leakage was the primary outcome parameter. Inflammation at the resection margin was characterized as "inflammation at proximal resection margin", "inflammation at distal resection margin" or "inflammation at both ends".

Results: 46 patients (35.4%) showed microscopic inflammation at the resection margins. 17 patients (13.1%) developed anastomotic leakage. No difference in the rate of anastomotic leakages was found for proximally affected resection margins (no anastomotic leakage vs. anastomotic leakage: 20.3 vs. 35.3%, p = 0.17), distally affected resection margins (2.7 vs. 5.9%, p = 0.47) or inflammation at both ends (9.7 vs. 11.8%, p = 0.80). No effect on the anastomotic leakage rate was found for preoperative hemoglobin concentration (no anastomotic leakage vs. anastomotic leakage: 12.3 vs. 13.5 g/dl, p = 0.26), perioperative immunosuppressive medication (62.8 vs. 52.9%, p = 0.30), BMI (21.8 vs. 22.4 m2/kg, p = 0.82), emergency operation (21.2 vs. 11.8%, p = 0.29), laparoscopic vs. open procedure (p = 0.58), diverting ileostomy (31.9 vs. 57.1%, p = 0.35) or the level of surgical training (staff surgeon: 80.5 vs. 76.5%, p = 0.45).

Conclusion: Microscopic inflammation at the resection margins after ileocecal resection in Crohn's disease is common. Histologically inflamed resection margins do not appear to affect the rate of anastomotic leakages. Our data suggest that there is no need for extensive resections or frozen section to achieve microscopically inflammation-free resection margins.

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Conflict of interest statement

The authors have declared that no competing interests exist.

References

    1. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al.. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390: 2769–2778. 10.1016/S0140-6736(17)32448-0 - DOI - PubMed
    1. Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn’s disease. Dis Mon. 2018;64: 20–57. 10.1016/j.disamonth.2017.07.001 - DOI - PubMed
    1. Yamamoto T, Allan RN, Keighley MR. Risk factors for intra-abdominal sepsis after surgery in Crohn’s disease. Dis Colon Rectum. 2000;43: 1141–1145. 10.1007/BF02236563 - DOI - PubMed
    1. Ghoneima AS, Flashman K, Dawe V, Baldwin E, Celentano V. High risk of septic complications following surgery for Crohn’s disease in patients with preoperative anaemia, hypoalbuminemia and high CRP. Int J Colorectal Dis. 2019;34: 2185–2188. 10.1007/s00384-019-03427-7 - DOI - PubMed
    1. Galata C, Kienle P, Weiss C, Seyfried S, Reißfelder C, Hardt J. Risk factors for early postoperative complications in patients with Crohn’s disease after colorectal surgery other than ileocecal resection or right hemicolectomy. Int J Colorectal Dis. 2019;34: 293–300. 10.1007/s00384-018-3196-2 - DOI - PubMed

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