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P459. Is preoperative use of biologics in abdominal surgery with bowel anastomosis for Crohn's disease safe?

P. Myrelid1, M. Marti-Gallostra2, S. Ashraf3, M.L. Sunde4, T. Øresland4, V. Robles5, M. Tholin1, R. Lovegrove3, D. Humes6, A. Tøttrup7, D. Kjaer7, B. George3, 1Linköping University Hospital, Dept of Surgery, Linköping, Sweden, 2University Hospital of Valle de Hebron, Colorectal Surgery, Barcelona, Spain, 3Oxford University Hospitals, Colorectal Surgery, Oxford, United Kingdom, 4Akershus University Hospital, Dept of Surgery, Oslo, Norway, 5University Hospital of Valle de Hebron, Gastroenterology, Barcelona, Spain, 6Nottingham University Hospitals, Dept of Surgery, Nottingham, United Kingdom, 7Aarhus University Hospital, Dept of Gastroenterological Surgery, Aarhus, Denmark

Background

The use of biologics (anti-TNF therapy) is well established in the treatment of Crohn's disease (CD). Surgery for Crohn's disease involving intestinal anastomoses is associated with high morbidity1. Malnutrition, intra-abdominal sepsis, corticosteroids and emergency surgery have been shown to be associated with an increase in anastomotic leakage. The aim of this study was to assess the effect of biologics on the healing of bowel anastomosis in abdominal surgery for Crohn's disease.

Methods

All patients receiving biologics and undergoing abdominal surgery with anastomosis and/or strictureplasty during 2005–2011 were identified at six referral centres in inflammatory bowel disease.

Results

The 111 patients in the treatment group were compared with the 187 patients in the control group. Groups were similar regarding background data, indications to and priority of surgery. Any kind of complication occurred in 34.2%, anastomotic complications in 7.2% and infectious complications in 23.4% of those on biologics. Corresponding figures for the control group did not differ and was 28.9%, 8.0% and 21.9%. The median postoperative stay in hospital was 7 (2–101) days with no difference between the two groups. The use of biologics did not influence the length of stay even if there was an anastomotic complication (14.5 vs. 27 days, p = 0.10) or a severe complication (Clavien-Dindo ≥3) (13.5 vs. 26 days, p = 0.20). The type of disease (inflammatory, stricturing or penetrating), presence of perianal disease, smoking, and number of previous operations for CD, body mass index, indication or timing of surgery did not affect the postoperative outcome.

Conclusion

Concurrent treatment with biologics is not associated with an increased risk of complications after abdominal surgery with anastomosis and/or strictureplasty in Crohn's disease. An anastomosis seems safe in an elective operation on a well-nourished patient, without intra-abdominal sepsis and steroids.