Document Detail


Recurrence of Crohn's disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial.
MedLine Citation:
PMID:  19502857     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: This study attempts to determine whether stapled side-to-side anastomosis, compared with handsewn end-to-end anastomosis, results in decreased recurrence of Crohn's disease following ileocolic resection.
METHODS: Patients with Crohn's disease who underwent an ileocolic resection were randomized to side-to-side anastomosis or end-to-end anastomosis. Colonoscopy was performed at 12 months. The primary outcome was endoscopic recurrence, while the secondary outcome was symptomatic recurrence (defined as symptoms attributable to Crohn's disease and severe enough to warrant treatment, plus endoscopic disease recurrence).
RESULTS: One hundred and thirty-nine subjects were included in the efficacy analysis. After a mean follow-up of 11.9 months, the endoscopic recurrence rate was 42.5 percent in the end-to-end anastomosis group, compared with 37.9 percent in the side-to-side anastomosis group (-4.6 percent difference; 95 percent confidence interval -21.0 to 11.9 percent; P = 0.55). The symptomatic recurrence rate was 21.9 percent in the end-to-end anastomosis group, compared with 22.7 percent in the side-to-side anastomosis group (+0.8 percent difference; 95 percent confidence interval -13.2 to 15.3 percent; P = 0.92). In multivariate logistic regression analysis, previous resections were predictive of a higher risk of both endoscopic (odds ratio 1.78; 95 percent confidence interval 1.06 to 2.90; P = 0.028) and symptomatic (odds ratio 2.0; 95 percent confidence interval 1.14 to 3.60; P = 0.0016) recurrence. Compliance with postoperative maintenance therapy was predictive of a lower risk of symptomatic recurrence (odds ratio 0.13, 95 percent confidence interval 0.01 to 0.78; P = 0.021).
CONCLUSION: Recurrence rates are similar whether end-to-end anastomosis or side-to-side anastomosis is performed.
Authors:
Robin S McLeod; Bruce G Wolff; Sue Ross; Robert Parkes; Margaret McKenzie;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  52     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-06-08     Completed Date:  2009-07-28     Revised Date:  2011-04-19    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  919-27     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Toronto, Toronto, Ontario, Canada. rmcleod@mtsinai.on.ca
Data Bank Information
Bank Name/Acc. No.:
ISRCTN/ISRCTN72500766
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MeSH Terms
Descriptor/Qualifier:
Adult
Anastomosis, Surgical / methods*
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Azathioprine / therapeutic use
Colon / surgery*
Crohn Disease / surgery*
Endoscopy, Gastrointestinal
Female
Humans
Ileum / surgery*
Immunosuppressive Agents / therapeutic use
Male
Medication Adherence
Mesalamine / therapeutic use
Multivariate Analysis
Recurrence
Risk Factors
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 0/Immunosuppressive Agents; 446-86-6/Azathioprine; 89-57-6/Mesalamine
Investigator
Investigator/Affiliation:
Robin McLeod / ; Marg McKenzie / ; Maria Liu / ; Robert Parkes / ; Donald W Buie / ; Vi Todd / ; Sue Ross / ; Hugh MacDonald / ; Jackie McKay / ; Carol Anne Vasilevsky / ; Winnie Flores / ; Roger Gregoire / ; Louise Rousseau / ; Arthur Plewes / ; Norine Whalen / ; Richard Silverman / ; Barbara McEwen / ; Brian Taylor / ; Osvalda Bispo / ; Terry Phang / ; Judy Wilson / ; Carole Richard / ; Bruce G Wolff / ; Shar Allen / ; Scott Strong / ; Susan Tepper / ; Neil Hyman / ; Sean O'Brien / ; David Schoetz / ; Heidi Judge / ; James Fleshman / ; Michael Lewis / ; Walter A Koltun / ; Deborah Hoffman / ; Neil Mortensen / ; Lynne Lane /
Comments/Corrections
Comment In:
Gastroenterology. 2010 May;138(5):2010-2   [PMID:  20303965 ]
Inflamm Bowel Dis. 2010 Mar;16(3):539-40   [PMID:  19760782 ]
Inflamm Bowel Dis. 2011 Apr;17(4):1046-7   [PMID:  21391287 ]

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