Search in the Abstract Database

Abstracts Search 2019

P558 Iterative ileocolonic resection for Crohn’s disease: a prospective multi-centric cohort study of the GETAID Chirurgie

S. Abdalla1, A. Brouquet2, L. Maggiori3, P. Zerbib4, Q. Denost5, A. Germain6, E. Cotte7, L. Beyer-Berjot8, N. Munoz-Bongrand9, V. Desfourneaux10, A. Rahili11, J-P. Duffas12, K. Pautrat13, C. Denet14, V. Bridoux15, G. Meurette16, J-L. Faucheron17, J. Loriau18, F. Guillon19, E. Vicaut20, S. Benoist2, Y. Panis3, J. Lefevre*1

1Hopital saint antoine, General and Digestive surgery, Paris, France, 2CHU Bicètre, General and Digestive surgery, Le Kremlin-Bicètre, France, 3CHU Beaujon, Colorectal Surgery, Clichy, France, 4CHRU Lille, General Surgery, Lille, France, 5CHU Pessac, Colorectal Surgery, Bordeaux, France, 6CHU Nancy, General and Digestive surgery, Nancy, France, 7CHU Lyon-Sud, General and Digestive surgery, Lyon, France, 8CHU Nord, General and Digestive surgery, Marseille, France, 9CHU St-Louis, General and Digestive surgery, Paris, France, 10CHU Rennes, General and Digestive surgery, Rennes, France, 11CHU Nice, General and Digestive surgery, Nice, France, 12CHU Rangueil, General and Digestive surgery, Toulouse, France, 13CHU Lariboisière, General and Digestive surgery, Paris, France, 14Institut Monsouris, General and Digestive surgery, Paris, France, 15CHRU Rouen, General and Digestive surgery, Rouen, France, 16CHU Nantes, General and Digestive surgery, Nantes, France, 17CHU Grenoble, General and Digestive surgery, Grenoble, France, 18Hopital Saint-Jospeh, General and Digestive surgery, Paris, France, 19CHRU Montpellier, General and Digestive surgery, Montpellier, France, 20URC Fernand-Widal, Unité de Recherche clinique, Paris, France

Background

Iterative ileo-colic resection (IICR) for Crohn's disease is often required for patients. Previous retrospective studies highlighted an increased overall and surgical morbidity. However, large recent data are lacking on this frequent situation. The aim of this study was to compare perioperative characteristics and results between primary ileo-colonic resection (PICR) and IICR for Crohn’s disease in a prospective multi- centric cohort.

Methods

From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgical. Perioperative characteristics and postoperative results of both groups (431 PICR, 136 IICR) were compared. Uni- and multi-variate analyses of the risk factors of overall 30-days postoperative morbidity was carried out in the IICR group.

Results

IICR patients were less malnourished (27.2% vs. 39.9%, p = 0.007), with more stricturing phenotype (69.1% vs. 54.3% p = 0.003) and were older (11% > 65 years vs. 4.2%, p = 0.03). Preoperative treatment (steroids, anti-TNF) were not different between the two groups (p = 0.514). Laparoscopic approach was less frequently used for IICR (45.6% vs. 84.5%, p < 0.01) with an increased conversion rates (27.4% vs. 14.6%, p < 0.01). Operating time was significantly longer for IICR (155.9 vs. 138.9 min, p = 0.02). IICR patients presented less internal fistula (25% vs. 37.6%, p = 0.007), without differences in stoma rates (17.6% vs. 21.8%). Overall postoperative morbidity was 29.1%, increased in the IICR group (36.8% vs. 26.7%, p = 0.024), with more ileus (11.8% vs. 3.7%, p < 0.001), without difference in anastomotic leakage (AL) rate (8.8% vs. 8.4%) or prolonged length of stay (LOS) (IICR: 9.30 days ± 6.9 vs. PICR: 10.2 days ± 23.0, p = 0.499). Uni-and multi-variate analyses did not identify specific risk factors of overall postoperative morbidity in the IICR group and anti-TNF treatment was not associated with increased morbidity (41.3 vs. 40.2%, p = 0.460). After PRIC the post-operative outcomes were not modified by the number of surgical procedures (second (n = 97) vs. third or more (n = 39): conversion (p = 0.568), overall morbidity (p = 0.513) or intra-abdominal septic complication (p = 0.087).

Conclusion

IICR is more technically challenging but half of patients can be operated through a laparoscopic approach. Increased morbidity is linked to post-operative ileus. Anastomotic leakage and intra-abdominal sceptic complications are not different. Iterative ileo-colic resection should not be considered as a factor in favour of stoma creation.