Download PDF
Clin Colon Rectal Surg 2021; 34(06): 412-416
DOI: 10.1055/s-0041-1735273
Review Article

Special Considerations of Anastomotic Leaks in Crohn's Disease

N. Nimalan A. Jeganathan
1   Division of Colorectal Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Walter A. Koltun
1   Division of Colorectal Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
› Author Affiliations Funding This work was supported by the Peter and Marshia Carlino Early Career Professorship Award for Inflammatory Bowel Disease Research.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Rates of anastomotic leak following intestinal resections in the setting of inflammatory bowel disease are significantly influenced by clinical characteristics. While the literature can be contradictory due to significant heterogeneity in the published data, several common themes appear to consistently arise. With respect to Crohn's disease, low serum albumin, preoperative abscess, reoperative abdominal surgery, and steroid use are associated with an increased risk of postoperative intra-abdominal septic complications. On the contrary, biologic therapy, immunomodulator use, and method of anastomosis appear not to confer increased anastomotic-related complications. Undoubtedly, a low rate of anastomotic leakage is inherent to procedures within colorectal surgery but diligent attention must be paid to identify, optimize, and, therefore, reduce known risks.

Keywords

Crohn's disease - anastomotic leak - hypoalbuminemia - intra-abdominal abscess - steroids - biologics


Publication History

Article published online:
01 October 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg 2009; 208 (02) 269-278
    CrossrefPubMedSearch in Google Scholar
  • 2 Frolkis AD, Dykeman J, Negrón ME. et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 2013; 145 (05) 996-1006
    CrossrefPubMedSearch in Google Scholar
  • 3 Huang W, Tang Y, Nong L, Sun Y. Risk factors for postoperative intra-abdominal septic complications after surgery in Crohn's disease: a meta-analysis of observational studies. J Crohn's Colitis 2015; 9 (03) 293-301
    Search in Google Scholar
  • 4 Scholz AF, Oldroyd C, McCarthy K, Quinn TJ, Hewitt J. Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery. Br J Surg 2016; 103 (02) e21-e28
    CrossrefPubMedSearch in Google Scholar
  • 5 Patel KV, Darakhshan AA, Griffin N, Williams AB, Sanderson JD, Irving PM. Patient optimization for surgery relating to Crohn's disease. Nat Rev Gastroenterol Hepatol 2016; 13 (12) 707-719
    CrossrefPubMedSearch in Google Scholar
  • 6 Ward MW, Danzi M, Lewin MR, Rennie MJ, Clark CG. The effects of subclinical malnutrition and refeeding on the healing of experimental colonic anastomoses. Br J Surg 1982; 69 (06) 308-310
    CrossrefPubMedSearch in Google Scholar
  • 7 Lai CC, You JF, Yeh CY. et al. Low preoperative serum albumin in colon cancer: a risk factor for poor outcome. Int J Colorectal Dis 2011; 26 (04) 473-481
    CrossrefPubMedSearch in Google Scholar
  • 8 Donnellan CF, Yann LH, Lal S. Nutritional management of Crohn's disease. Therap Adv Gastroenterol 2013; 6 (03) 231-242
    CrossrefPubMedSearch in Google Scholar
  • 9 Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N Engl J Med 1991; 325 (08) 525-532
    CrossrefPubMedSearch in Google Scholar
  • 10 Jacobson S. Early postoperative complications in patients with Crohn's disease given and not given preoperative total parenteral nutrition. Scand J Gastroenterol 2012; 47 (02) 170-177
    CrossrefPubMedSearch in Google Scholar
  • 11 Heuschkel R. Enteral nutrition should be used to induce remission in childhood Crohn's disease. Dig Dis 2009; 27 (03) 297-305
    CrossrefPubMedSearch in Google Scholar
  • 12 Day AS, Lopez RN. Exclusive enteral nutrition in children with Crohn's disease. World J Gastroenterol 2015; 21 (22) 6809-6816
    CrossrefPubMedSearch in Google Scholar
  • 13 Li G, Ren J, Wang G. et al. Preoperative exclusive enteral nutrition reduces the postoperative septic complications of fistulizing Crohn's disease. Eur J Clin Nutr 2014; 68 (04) 441-446
    CrossrefPubMedSearch in Google Scholar
  • 14 Poritz LS, Koltun WA. Percutaneous drainage and ileocolectomy for spontaneous intraabdominal abscess in Crohn's disease. J Gastrointest Surg 2007; 11 (02) 204-208
    CrossrefPubMedSearch in Google Scholar
  • 15 Tzivanakis A, Singh JC, Guy RJ, Travis SPL, Mortensen NJ, George BD. Influence of risk factors on the safety of ileocolic anastomosis in Crohn's disease surgery. Dis Colon Rectum 2012; 55 (05) 558-562
    CrossrefPubMedSearch in Google Scholar
  • 16 Xie Y, Zhu W, Li N, Li J. The outcome of initial percutaneous drainage versus surgical drainage for intra-abdominal abscesses in Crohn's disease. Int J Colorectal Dis 2012; 27 (02) 199-206
    CrossrefPubMedSearch in Google Scholar
  • 17 Landsend E, Johnson E, Johannessen HO, Carlsen E. Long-term outcome after intestinal resection for Crohn's disease. Scand J Gastroenterol 2006; 41 (10) 1204-1208
    CrossrefPubMedSearch in Google Scholar
  • 18 Johnston WF, Stafford C, Francone TD. et al. What is the risk of anastomotic leak after repeat intestinal resection in patients with Crohn's disease?. Dis Colon Rectum 2017; 60 (12) 1299-1306
    CrossrefPubMedSearch in Google Scholar
  • 19 Aszodi A, Ponsky JL. Effects of corticosteroid on the healing bowel anastomosis. Am Surg 1984; 50 (10) 546-548
    PubMedSearch in Google Scholar
  • 20 Aberra FN, Lewis JD, Hass D, Rombeau JL, Osborne B, Lichtenstein GR. Corticosteroids and immunomodulators: postoperative infectious complication risk in inflammatory bowel disease patients. Gastroenterology 2003; 125 (02) 320-327
    CrossrefPubMedSearch in Google Scholar
  • 21 Brouquet A, Maggiori L, Zerbib P. et al; GETAID chirurgie group. Anti-TNF therapy is associated with an increased risk of postoperative morbidity after surgery for ileocolonic Crohn disease: results of a prospective nationwide cohort. Ann Surg 2018; 267 (02) 221-228
    CrossrefPubMedSearch in Google Scholar
  • 22 Cohen BL, Fleshner P, Kane SV. et al. Anti-tumor necrosis factor therapy is not associated with post-operative infection: results from prospective cohort of ulcerative colitis and Crohn's disease patients undergoing surgery to identify risk factors for post-operative infection (PUCCINI). Gastroenterol 2019; 125: S-80
    CrossrefPubMedSearch in Google Scholar
  • 23 Lightner AL, McKenna NP, Alsughayer A. et al. Biologics and 30-Day postoperative complications after abdominal operations for Crohn's disease: are there differences in the safety profiles?. Dis Colon Rectum 2019; 62 (11) 1352-1362
    CrossrefPubMedSearch in Google Scholar