P0657 Quality of ileocolic resection in Crohn’s disease- A systemic review and meta-analysis

Background

The terminal ileum is the most common site affected by Crohn’s disease and the area most commonly requiring surgical management. Post operatively, there is large heterogeneity between patient outcomes; with a proportion requiring no further medical or surgical management, whilst others will require life-long management with repeated operations. The reason for this remains unclear.

Surgical key performance indicators for an ileocolic resection can include: recurrence, rate of anastomotic leak, post-operative complications (Clavien Dindo (CD) >3), length of stay, re-admission rate and mortality.

The aim of this study was to evaluate the effects of mode of surgery, the extent of mesenteric excision and the type of anastomosis on the rate of recurrence.

Methods

A systematic review was conducted following a priori protocol. Covidence software was used to exclude duplicates, screen studies and extract data. Extracted data was analysed. The primary outcome was recurrence rate and the mode of detection. Secondary outcomes were; anastomotic leak, post-operative complications (CD >3), length of stay, readmission rate, mortality and duration of follow up. Combined overall effect size was calculated using SPSS software. The revised Cochrane risk of bias tool and the Newcastle-Ottawa scale were used to assess risk of bias.

Results

A total of 24 studies were included. Four (three randomised controlled trials (RCTs)) in the mode of surgery group, four in the extent of mesenteric resection group and sixteen (two RCTs) in the type of anastomosis group. In all four studies included in the mode of surgery group, laparoscopic surgery was associated with a shorter length of stay. No difference was observed in the other outcomes, including rate of recurrence. There was no significant correlation between extended versus limited mesenteric excision and the rate of recurrence (p0.307, OR 0.61 (CI95% -.056, 1.77)). Four studies compared Kono-S anastomosis versus non-Kono-S anastomosis. Kono-S anastomosis was associated with a significantly lower recurrence rate (p=0.002, OR 0.62 (CI95% 0.24, 1.01)). There was significant heterogeneity between these studies (p<0.001).

Conclusion

To date there is no convincing evidence that the mode of surgery, the extent of the mesenteric excision or the type of anastomosis have any significant effect on reducing the occurrence of Crohn’s recurrence at the anastomosis.

References

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