Postoperative Morbidity After Iterative Ileocolonic Resection for Crohn’s Disease: Should we be Worried? A Prospective Multicentric Cohort Study of the GETAID Chirurgie

Solafah Abdalla (1, 2) , Antoine Brouquet (3) , Léon Maggiori (4) , Philippe Zerbib (5) , Quentin Denost (6) , Adeline Germain (7) , Eddy Cotte (8) , Laura Beyer-Berjot (9) , Nicolas Munoz-Bongrand (10) , Véronique Desfourneaux (11) , Amine Rahili (12) , Jean-Pierre Duffas (13) , Karine Pautrat (14) , Christine Denet (15) , Valérie Bridoux (16, 17, 18, 19) , Guillaume Meurette (20) , Jean-Luc Faucheron (21) , Jérôme Loriau (22) , Françoise Guillon (23) , Eric Vicaut (15) , Stéphane Benoist (3) , Yves Panis (24) , Jérémie Lefèvre (2, 1)

1 CHU Saint-Antoine [AP-HP]
2 SU - Sorbonne Université
3 Service de Chirurgie générale et digestive [CHU Le Kremlin-Bicêtre]
4 Service de Gastroentérologie [Hôpital Beaujon]
5 Service de Chirurgie Générale et Digestive[Lille]
6 BIOTIS - Bioingénierie tissulaire
7 Service de Chirurgie Digestive Hépatobiliaire et Endocrine [CHRU Nancy]
8 EA3738 - Ciblage thérapeutique en Oncologie
9 LBA UMR T24 - Laboratoire de Biomécanique Appliquée
10 AP-HP - Hopital Saint-Louis [AP-HP]
11 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
12 CHU Nice - Centre Hospitalier Universitaire de Nice
13 Chirurgie Générale et Digestive [Rangueil]
14 Hôpital Lariboisière-Fernand-Widal [APHP]
15 Hôpital Lariboisière
16 Service de Chirurgie Digestive [CHU Rouen]
17 ADEN - Nutrition, inflammation et dysfonctionnement de l'axe intestin-cerveau
18 IRIB - Institute for Research and Innovation in Biomedicine
19 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
20 Hôtel Dieu - Service de Chirurgie Digestive et Endocrinienne [CHU Nantes]
21 Service de Chirurgie Digestive, [CHRU Grenoble], La Tronche
22 Service de Chirurgie digestive [GH Paris Saint-Joseph]
23 Département de chirurgie digestive, [CHU Montpellier]
24 Hôpital Beaujon

BACKGROUND AND AIMS: To compare perioperative characteristics and outcomes between primary ileocolonic resection [PICR] and iterative ileocolic resection [IICR] for Crohn's disease [CD]. METHODS: From 2013 to 2015, 567 patients undergoing ileocolonic resection were prospectively included in 19 centres of the GETAID chirurgie group. Perioperative characteristics and postoperative results of both groups [431 PICR, 136 IICR] were compared. Uni- and multivariate analyses of the risk factors of overall 30-day postoperative morbidity was carried out in the IICR group. RESULTS: IICR patients were less likely to be malnourished [27.2% vs 39.9%, p = 0.007], and had more stricturing forms [69.1% vs 54.3%, p = 0.002] and less perforating disease [19.9% vs 39.2%, p < 0.001]. Laparoscopy was less commonly used in IICR [45.6% vs 84.5%, p < 0.01] and was associated with increased conversion rates [27.4% vs 14.6%, p = 0.012]. Overall postoperative morbidity was 36.8% in the IICR group and 26.7% in the PICR group [p = 0.024]. There was no significant difference between IICR and PICR regarding septic intra-abdominal complications, anastomotic leakage [8.8% vs 8.4%] or temporary stoma requirement. IICR patients were more likely to present with non-infectious complications and ileus [11.8% vs 3.7%, p < 0.001]. Uni- and multivariate analyses did not identify specific risk factors of overall postoperative morbidity in the IICR group. CONCLUSIONS: Surgery for recurrent CD is associated with a slight increase of non-infectious morbidity [postoperative ileus] that mainly reflects the technical difficulties of these procedures. However, IICR remains a safe therapeutic option in patients with recurrent CD because severe morbidity including anastomotic complications is similar to patients undergoing primary resection.

Keywords: morbidity; ileo-colic resection; Crohn’s disease; recurrent disease

Domains: Hépatology and Gastroenterology; Surgery; Santé publique et épidémiologie

Solafah Abdalla, Antoine Brouquet, Léon Maggiori, Philippe Zerbib, Quentin Denost, et al.. Postoperative Morbidity After Iterative Ileocolonic Resection for Crohn’s Disease: Should we be Worried? A Prospective Multicentric Cohort Study of the GETAID Chirurgie. Journal of Crohn's and Colitis, 2019, 13 (12), pp.1510-1517. ⟨10.1093/ecco-jcc/jjz091⟩. ⟨hal-02362759⟩