Positive Histological Inflammatory Margins Are Associated With Increased Risk for Intra-abdominal Septic Complications in Patients Undergoing Ileocolic Resection for Crohn’s Disease

Abstract

Rates of postoperative complications are particularly high among patients with Crohn's disease. The aim of this study was to assess whether positive inflammatory histological margins, among other factors, pose a risk for intra-abdominal septic complications in patients with Crohn's disease undergoing ileocolic resection. A retrospective study of patient records, during 2000-2010, was conducted. This investigation was performed at a single medical center. Included were 166 individuals with Crohn's disease (85 males, mean age 35.6). Ileocolic resection with primary anastomosis was performed. The primary outcomes measured were postoperative intra-abdominal septic complications. Twenty-five patients (15%) developed intra-abdominal septic complications, including anastomotic leak, intra-abdominal abscesses and collections, and enterocutaneous fistulas. There were no postoperative deaths. Univariate analysis revealed that a long course of disease before surgery, an emergency surgery, steroid treatment of more than 3 months before surgery, additional sigmoidectomy, and positive surgical margins detected on histopathological examination were associated with intra-abdominal septic complications. In a multivariate analysis, only disease duration longer than 10 years (OR 4.575 (CI 1.592-13.142), p = 0.005), additional sigmoidectomy (OR 5.768 (CI 1.088-30.568), p = 0.04), and positive histological resection margins (OR 2.996 (CI 1.085-8.277), p = 0.03) were found to be independent risk factors. This study was limited by the incomplete data regarding preoperative albumin levels. Positive histological margins, disease duration of more than 10 years, and added sigmoidectomy are independent risk factors that are associated with postoperative intra-abdominal septic complications in patients undergoing ileocolic resection for Crohn's disease. These risk factors should be considered when the need for a diverting stoma is questionable. A frozen section of the margins may assist in the decision as to a temporary ileostomy construction.