Redo ileocolic resection for recurrent Crohn’s disease: A review and meta-analysis of surgical outcomes

• Published in: Surgery 2022-12, Vol.172 (6), p.1614-1621
• Main Authors: Freund, Michael R., Emile, Sameh Hany, Horesh, Nir, Garoufalia, Zoe, Gefen, Rachel, Perets, Michal, Wexner, Steven D.
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical - adverse effects; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Anastomotic Leak - surgery; Colectomy - adverse effects; Crohn Disease - complications; Crohn Disease - surgery; Female; Humans; Ileum - surgery; Male; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Retrospective Studies; Treatment Outcome
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2022.09.003

Recurrence of postoperative Crohn’s disease neccesitating repeat ileocolic resection is a common problem. The aim of this meta-analysis was to present the collective evidence on the surgical outcomes of this procedure. PubMed, Scopus, and Google Scholar were searched for eligible studies that reported the surgical outcomes of redo ileocolic resection for Crohn’s disease. The primary outcomes were overall and major complication rates. The secondary outcome was anastomotic leak and conversion rate. Risk of bias was assessed using the Risk of Bias in Non-Randomized Studies – of Interventions tool. This meta-analysis included 12 studies comprising 1,203 patients (50% men). The weighted mean rate of overall complications was 31.8% (95% confidence interval, 25–38.6) and rate of major complications was 8% (95% confidence interval, 5.7–10.2). The weighted mean rate of conversion was 20.9%, and the weighted mean rate of anastomotic leak was 3% (95% confidence interval, 1.8%–4.3%; inconsistency = 0). Male sex (slope coefficient = 0.0001; P = .01), American Society of Anesthesiologists score >3 (slope coefficient = 0.001; P = .04), smoking (slope coefficient = 0.0001; P = .008), preoperative use of steroid therapy (slope coefficient = 0.0001; P = .009), open approach (slope coefficient = 0.0001; P = .005), and having ≥2 previous resections (slope coefficient = 0.0001; P = .02) were significant risk factors for major complications. Although redo ileocolic resection for patients with recurrent Crohn disease has a relatively high overall complication rate, a majority of these complications are minor and anastomotic leak rate is relatively low. Further prospective multicenter trials are warranted to confirm the conclusions of this meta-analysis.