Ileocolic Resection For Crohn's Disease Research Articles

How Reliable Is Endoscopic Scoring of Postoperative Recurrence in Crohn Disease?: A Systematic Review and Meta-Analysis

Objective: Guidelines advise to perform endoscopic surveillance following ileocolic resection (ICR) in Crohn disease (CD) for timely diagnosis of recurrence. This study aims to assess the variation in endoscopic recurrence (ER) rates in patients after ICR for CD using the most commonly used classification systems, the Rutgeerts score (RS) and modified Rutgeerts score (mRS) classifications. Methods: A systematic literature search using MEDLINE, Embase, and the Cochrane Library was performed. Randomized controlled trials and cohort studies describing ER < 12 months after an ICR for CD were included. Animal studies, reviews, case reports (<30 included patients), pediatric studies, and letters were excluded. The Newcastle–Ottawa Quality Assessment Scale and Cochrane Collaboration’s tool were used to assess risk of bias. Main outcome was the range of ER rates within 12 months postoperatively, defined as RS ≥ i2 and/or mRS ≥ i2b. A proportional meta-analysis was performed. The final search was performed on January 4, 2022. The study was registered at PROSPERO, CRD42022363208. Results: Seventy-six studies comprising 7751 patients were included. The weighted mean of ER rates in all included studies was 44.0% (95% confidence interval, 43.56–44.43). The overall range was 5.0% to 93.0% [interquartile range (IQR), 29.2–59.0]. The weighted means for RS and mRS were 44.0% and 41.1%, respectively. The variation in ER rates for RS and mRS were 5.0% to 93.0% (IQR, 29.0–59.5) and 19.8% to 62.9% (IQR, 37.3–46.5), respectively. Within studies reporting both RS and mRS, the weighted means for ER were 61.3% and 40.6%, respectively. Conclusions: This study demonstrates a major variation in ER rates after ICR for CD, suggesting a high likelihood of inadequate diagnosis of disease recurrence, with potentially impact on quality of life and health care consumption. Therefore, there is an important need to improve endoscopic scoring of recurrent disease.

Hospital surgical volume-outcome relationship of postoperative morbidity for ileocolic resection in Crohn's disease: A French nationwide study of 4,205 patients.

Despite the development of medical therapy, nearly 50% of patients with Crohn's disease (CD) undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity (POM) after ileocolic resection (ICR). However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD. All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical volume (≥6 ICR/year) and low-surgical volume centers (<6 ICR/year). The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume center. The Elixhauser comorbidity index (ECI) was used to categorize the comorbidities of patients. A total of 4,205 patients were identified, and the major POM during hospitalization was significantly (p = 0.0004) lower in the high-surgical volume (6.2%) compared to low-surgical volume centers (9.1%). After multivariate analysis, independent factors associated with major POM were surgical hospital volume (P = 0.024), male sex (P = 0.029), ECI ≥1 (P < 0.001), and minor POM (P < 0.001). Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing after outpatient breast surgery: Time for a streamlined approach?07. Trends in graduate degree types and research output for Canadian academic general surgeons08. Would you prefer to undergo breast-conserving therapy or a mastectomy for early breast cancer? Comparison of perceptions of general and plastic surgeons09. Lack of representation of women and BIPOC individuals in Canadian academic surgery10. Medical student interest and perspectives on pursuing surgical careers: a multicentre survey evaluating 5-year trends11. Difficult cholecystectomy with cholecystogastric fistula12. Surviving nonsurvivable injuries: patients who elude the “lethal” Abbreviated Injury Scale (AIS) score of six13. Gunshot wounds sustained during legal intervention v. those inflicted by civilians: a comparative analysis14. The impact of delayed time to first head CT on functional outcomes after blunt head trauma with moderately depressed GCS15. Contemporary utility of diagnostic peritoneal aspiration in trauma16. Impact of delayed time to first head CT in traumatic brain injury17. Radiologic predictors of in-hospital mortality after traumatic craniocervical dissociation18. Measurement properties of a patient-reported instrument to evaluate functional status after major surgery19. The safety of venous thromboembolism chemoprophylaxis use in endoscopic retrograde cholangiopancreatography20. Characterizing Canadian rural surgeons: trends over time and 10-year replacement needs21. Contextual interference for skills development and transfer in laparoscopic surgery: a randomized controlled trial22. Evaluating the accuracy and design of visual backgrounds in academic surgical journals23. Defining rural surgery in Canada24. Validity of video-based general and procedure-specific self-assessment tools for surgical trainees in laparoscopic cholecystectomy25. Examining the equity and diversity characteristics of academic general surgeons in Canada26. Video-based coaching for surgical residents: a systematic review and meta-analysis27. Very-low-energy diets prior to nonbariatric surgery: a systematic review and meta-analysis28. Factors associated with resident research success: a descriptive analysis of Canadian general surgery trainees29. Global surgery pilot curriculum in Canadian undergraduate medical education: a novel approach30. How useful is ultrasound in predicting surgical findings of “mild cholecystitis”?31. Implementing a colorectal surgery “virtual hospital”: description of a novel outpatient care pathway to advance surgical care32. Trends in training and workforce planning for Canadian pediatric surgeons: a 10-year model33. Patient perspectives on intraoperative blood transfusion: results of semistructured interviews with perioperative patients34. Understanding intraoperative transfusion decision-making variability: a qualitative study using the Theoretical Domains Framework35. Effectiveness of preoperative oscillating positive expiratory pressure (OPEP) therapy in reduction of postoperative respiratory morbidity in patients undergoing surgery: a systematic review37. Accuracy of point-of-care testing devices for hemoglobin in the operating room: a systematic review and meta-analysis38. Opioid-free analgesia after outpatient general surgery: a qualitative study focused on the perspectives of patients and clinicians involved in a pilot trial39. The impact of the COVID-19 pandemic on general surgery residency: an analysis of operative volumes by residents at a Canadian general surgery residency program40. Postoperative care protocols for elderly emergency surgical patients: a quality improvement initiative42. Adverse events following robotic compared to laparoscopic and open surgery: a population-based analysis43. Is accrual higher for patients randomized to pragmatic v. exploratory randomized clinical trials? A systematic review and meta-analysis44. Effect of preoperative proton-pump inhibitor use on postoperative infectious and renal complications after elective general surgery45. The early burden of COVID-19 in emergency general surgery care across Canada46. Laparoscopic subtotal cholecystectomy for the difficult gallbladder: evolution of technique at a single teaching hospital and retrospective review47. The demand for emergency general surgery in Canada: a public health crisis48. Attitudes of Canadian general surgery staff and residents toward point-of-care ultrasound49. Psychological impact of COVID-19 on Canadian surgical residents50. Validation of an artificial intelligence platform for the guidance of safe laparoscopic cholecystectomy51. Predictors of recurrent appendicitis after nonoperative management: a prospective cohort study52. The effect of the first wave of the COVID-19 pandemic on colorectal and hepatobiliary oncologic outcomes at a tertiary care centre53. Trends in training and workforce representation for Canadian general surgeons working in critical care: a descriptive study54. White presentation: teaching safe opioid prescription and opioid use disorder management in Canadian universities56. How bad is really bad, eh? Impact of the first wave of the COVID-19 pandemic on residents’ operative volume: the experience of a Canadian general surgery program57. Surgeon-specific encounters within a multidisciplinary care pathway: Is there a role for shared care models in surgery?59. A pan-Canadian analysis of approach to treatment for acute appendicitis60. Appendix neoplasm stratified by age: understanding the best treatment for appendicitis61. Predicting acute cholecystitis on final pathology to prioritize surgical urgency: an evaluation of the Tokyo criteria and development of a novel predictive score62. Obesity is an independent predictor of acute renal failure after surgery64. Validation of a clinical decision-making assessment tool in general surgery65. Moral distress in the provision of palliative care delivery for surgical patients in British Columbia: lessons learned from the perspectives of general surgeons66. Delays in presentation and severity of illness predict adverse surgical outcomes among patients transferred from rural Indigenous communities for acute care surgery67. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial68. Modified Delphi consensus on appropriate use of laboratory investigations in acute care surgery patients72. Impacts of inpatient food at a tertiary care centre on patient satisfaction, nutrition and planetary health73. Racial disparities in health outcomes for oncological surgery in Canada75. Risk of recurrent laryngeal nerve injury from thyroidectomy is lower when intraoperative nerve monitoring (IONM) is used: an analysis of 17 688 patients from the NSQIP database01. The impact of the COVID-19 pandemic on non-smallcell lung cancer pathologic stage and presentation02. Screening criteria evaluation for expansion in pulmonary neoplasias (screen)03. Robotic-assisted lobectomy for early-stage lung cancer provides better patient-reported quality of life than video-assisted lobectomy: early results of the RAVAL trial04. Breathe Anew: designing and testing the feasibility of a novel intervention for lung cancer survivorship05. Learning objectives for thoracic surgery: developing a national standard for undergraduate medical education06. Plasma cell-free DNA as a point-of-care well-being biomarker for early-stage non-small-cell lung cancer patients07. Sarcopenia determined by skeletal muscle index predicts overall survival, disease-free survival and postoperative complications in resectable esophageal cancer: a systematic review and meta-analysis08. The short- and long-term effects of open v. minimally invasive thymectomy in myasthenia gravis patients: a systematic review and meta-analysis09. Optimizing opioid prescribing practices following minimally invasive lung resections through a structured quality improvement process10. Effects of virtual postoperative postdischarge care in patients undergoing lung resection during the COVID-19 pandemic11. Initiating Ethiopia’s first minimally invasive surgery program: a novel approach for collaborations in global surgical education12. Patient outcomes following salvage lung cancer surgery after definitive chemotherapy or radiation13. Replacing chest X-rays after chest tube removal with clinical assessment in postoperative thoracic surgery patients14. Updating the practice of thoracic surgery in Canada: a survey of the Canadian Association of Thoracic Surgeons15. The impact of COVID-19 on the diagnosis and treatment of lung cancer16. Development of a prediction model for survival time in esophageal cancer patients treated with resection17. The development and validation of a mixed reality thoracic surgical anatomy atlas18. Routine placement of feeding tubes should be avoided in esophageal cancer patients undergoing surgery19. Nodal count is no different during robotic segmentectomy compared with robotic lobectomy20. Point-of-care ultrasound-guided percutaneous biopsy of solid masses in the thoracic outpatient clinic: a safe, high-yield procedure to accelerate tissue diagnosis for patients with advanced thoracic malignancy21. Sarcopenia and modified frailty index are not associated with adverse outcomes after esophagectomy for esophageal cancer: a retrospective cohort study22. Near-infrared-guided segmental resection for lung cancer: an analysis of the learning curve23. Routine use of feeding jejunostomy tubes in patients undergoing esophagectomy for esophageal malignancy is safe and associated with low complication rates01. Ghost ileostomy versus loop ileostomy following total mesorectal excision for rectal cancer: a systematic review and meta-analysis02. Analysis of 100 consecutive colorectal cancers presenting at a Canadian tertiary care centre: delayed diagnosis and advanced disease03. Clinical delays and comparative outcomes in younger and older adults with colorectal cancer: a systematic review04. Recurrence rates of rectal cancer after transanal total mesorectal excision (taTME): a systematic review and meta-analysis05. Transanal total mesorectal excision for abdominoperineal resection (taTME-APR) is associated with poor oncological outcomes in rectal cancer patients: a word of caution from a multicentric Canadian cohort study06. Association between survival and receipt of recommended and timely treatment in locally advanced rectal cancer: a population-based study07. Trends and the impact of incomplete preoperative staging in rectal cancer08. Postoperative outcomes after elective colorectal surgery in patients with cirrhosis09. Bowel stimulation before loop ileostomy closure to reduce postoperative ileus: a multicentre, single-blinded, randomized controlled trial10. Recurrence following perineal rectosigmoidectomy ( Altemeier) with levatorplasty: a systematic review and meta-analysis11. Nonmodifiable risk factors and receipt of surveillance investigations following treatment of rectal cancer12. Safety and effectiveness of endoscopic full-thickness resection for the management of colorectal lesions: a systematic review and meta-analysis13. Impact of preoperative carbohydrate loading before colectomy: a systematic review and meta-analysis of randomized controlled trials14. Statin therapy in patients undergoing short-course neoadjuvant radiotherapy for rectal cancer15. Feasibility of targeted lymphadenectomy during complete mesocolic excision for colon cancer using indocyanine green immunofluorescence lymphatic mapping16. Feasibility of expanding an ambulatory colectomy protocol: a retrospective analysis of early discharge following minimally invasive colectomy in an enhanced recovery pathway17. Impact of rectal cancer on bowel dysfunction before treatment and its relationship with post-treatment function18. Canadian cost–utility analysis of artificial-intelligence-assisted colonoscopy for adenoma detection in fecal immunochemical-based colorectal cancer screening19. A comparison of outcomes following intracorporeal and extracorporeal anastomotic techniques in laparoscopic right colectomies20. Assessment of metabolic signatures using desorption electrospray ionization mass spectrometry (DESI) and rapid evaporative ionization mass spectrometry (REIMS) of rectal cancer samples to assist in determining treatment response21. The association between hospital characteristics and minimally invasive rectal cancer surgery: a population-based study22. Cancer centre level designation and the impact on treatment and outcomes in those with rectal cancer: a population-based study23. Oncological outcomes after colorectal cancer in patients with liver cirrhosis: a systematic review and meta-analysis24. Optimal preoperative nutrition for penetrating Crohn disease: a systematic review and meta-analysis25. Lymph node ratio as a predictor of survival for colon cancer: a systematic review and meta-analysis26. Barriers and facilitators for use of new recommendations for optimal endoscopic localization of colorectal neoplasms according to gastroenterologists and surgeons27. Emergency colorectal surgery in patients with cirrhosis: a population-based descriptive study28. Local recurrence rates and associated risk factors after transanal endoscopic microsurgery for benign polyps and adenocarcinomas29. Bowel dysfunction impacts mental health after restorative proctectomy for rectal cancer30. Evolution of psychological morbidity following restorative proctectomy for rectal cancer: a systematic review and meta-analysis31. Frailty predicts LARS and quality of life in rectal cancer survivors after restorative proctectomy32. Low anterior resection syndrome in a reference North American population: prevalence and predictive factors33. The evolution of enhanced recovery: same day discharge after laparoscopic colectomy34. Effect of ERAS protocols on length of stay after colorectal surgery: an interrupted time series analysis35. Practice patterns and outcomes in individuals with cirrhosis and colorectal cancer: a population-based study36. Understanding the impact of bowel function on quality of life after rectal cancer surgery37. Right-sided colectomies for diverticulitis have worse outcomes compared with left-sided colectomies38. Symptom burden and time from symptom onset to cancer diagnosis in patients with early-onset colorectal cancer39. The impact of access to robotic rectal surgery at a tertiary care centre: a Canadian perspective40. Management of rectal neuroendocrine tumours by transanal endoscopic microsurgery41. The gut microbiota modulates colorectal anastomotic healing in patients undergoing surgery for colorectal cancer42. Is there added risk of complications for concomitant procedures during an ileocolic resection for Crohn disease?43. Cost of stoma-related hospital readmissions for rectal cancer patients following restorative proctectomy with a diverting loop ileostomy: a nationwide readmissions database analysis44. Older age associated with quality of rectal cancer care: an ACS-NSQIP database study45. Outcomes of patients undergoing elective bowel resection before and after implementation of an anemia screening and treatment program47. Loop ileostomy closure as a 23-hour stay procedure: a randomized controlled trial48. Extended duration perioperative thromboprophylaxis with low-molecular-weight heparin to improve disease-free survival following surgical resection of colorectal cancer: a multicentre randomized controlled trial (PERIOP-01 Trial)49. Three-stage versus modified 2-stage ileal pouch anal anastomosis: perioperative outcomes, function and quality of life50. Compliance with extended venous thromboembolism prophylaxis in rectal cancer51. Extended-duration venous thromboembolism prophylaxis after diversion in rectal cancer52. Financial and occupational impact of low anterior resection syndrome: a qualitative study53. Nonoperative management for rectal cancer: patient perspectives54. Trends in ileostomy-related emergency department visits for rectal cancer patients55. Long-term implications of treatment of fecal incontinence: a single Canadian centre’s retrospective cohort study: a 17-year follow-up56. Externally benchmarking colorectal resection outcomes in our province against the ACS NSQIP risk calculator: identifying opportunities for improvement57. Externally benchmarking our provincial colectomy outcomes against the ACS NSQIP using the Codman Score: to identify possible opportunities for improvement of outcomes58. Rural v. urban documentation of recommended practices for optimal endoscopic colorectal lesion localization01. Incidence of in-hospital opioid use and pain after inguinal hernia repair02. Ventral hernia repair following liver transplantation: outcome of repair techniques and risk factors for recurrence01. Impact of the COVID-19 pandemic on bariatric surgery in North America: a retrospective analysis of 834 647 patients02. Patient selection and 30-day outcomes of SADI-S compared to RYGB: a retrospective cohort study of 47 375 patients03. New persistent opioid use following bariatric surgery: a systematic review and pooled proportion meta-analysis04. Bariatric surgery should be offered to active-duty military personnel: a retrospective study of the Canadian Armed Forces experience05. Opioid prescribing practices and use following bariatric surgery: a systematic review and pooled summary of data06. Sacred sharing circles: urban Indigenous Manitobans’ experiences with bariatric surgery07. Gastrogastric hernia after laparoscopic gastric great curve plication: a video presentation08. Characterization of comorbidities predictive of bariatric surgery09. Efficacy of preoperative high-dose liraglutide in patients with superobesity10. The effect of linear stapled gastrojejunostomy size in Roux-en-Y gastric bypass11. Fragility of statistically significant outcomes in randomized trials comparing bariatric surgeries12. Weight loss outcomes for patients undergoing conversion to Roux-en-Y gastric bypass after sleeve gastrectomy13. Are long waiting lists for bariatric surgery detrimental to patients? A single-centre experience14. Does upper gastrointestinal swallow study after bariatric surgery lead to earlier detection of leak?15. Pharmaceutical utilization before and after bariatric surgery16. Same-day discharge Roux-en-Y gastric bypass at a Canadian bariatric centre: pathway implementation and early experiences17. Safety and efficiency of performing primary bariatric surgery at an ambulatory site of a tertiary care hospital: a 5-year experience18. Impact of psychiatric diagnosis on weight loss outcomes 3 years after bariatric surgery19. Ursodeoxycholic acid (UDCA) for prevention of gallstone disease after laparoscopic sleeve gastrectomy (LSG): an Atlantic Canada perspective20. Fecal microbial transplantation and fibre supplementation in patients with severe obesity and metabolic syndrome: a randomized double-blind, placebo-controlled phase 2 trial01. Incidence, timing and outcomes of venous thromboembolism in patients undergoing surgery for esophagogastric cancer: a population-based cohort study04. Omission of axillary staging and survival in elderly women with early-stage breast cancer: a population-based cohort study05. Patients’ experiences receiving cancer surgery during the COVID-19 pandemic: a qualitative study06. Cancer surgery outcomes are better at high-volume centres07. Attitudes of Canadian colorectal cancer care providers toward liver transplantation for colorectal liver metastases: a national survey08. Quality of narrative central and lateral neck dissection reports for thyroid cancer treatment suggests need for a national standardized synoptic operative template09. Transoral endoscopic thyroidectomy vestibular approach (TOETVA): indications and technique10. Temporal trends in lymph node assessment as a quality indicator in colorectal cancer patients treated at a high-volume Canadian centre11. Molecular landscape of early-stage breast cancer with nodal metastasis12. 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# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Factors associated with stoma formation in ileocolic resection for Crohn's disease and the development of a predictive scoring system.

The likelihood of a stoma following ileocolic resection (ICR) for Crohn's disease (CD) is an important consideration. This study aims to identify the factors associated with an increased likelihood of a stoma and develop a predictive scoring system (SS). Patient data were collected from St. Marks Hospital, London, UK and Humanitas Clinical and Research Center, Milan, Italy, on all patients who underwent an ICR for CD from 2005 to 2017. A logistic regression analysis was used for multivariate analysis. The SS was developed from the logistic regression model. The performance of the SS was evaluated using receiver operating characteristics area under the curve (AUROC). A total of 628 surgeries were included in the analysis. Sixty-nine surgeries were excluded due to missing data. The remaining 559 were divided into two cohorts for the scoring system's development (n = 434) and validation (n = 125). The regression model was statistically significant (p < 0.0001). The statistically significant independent variables included sex, preoperative albumin and haemoglobin levels, surgical access and simultaneous colonic resection. The AUROC for the development and validation cohorts were 0.803 and 0.905, respectively (p < 0.0001). Youden's index suggested the cut-off score of - 95.9, with a sensitivity of 87.6% and a specificity of 62.9%. Male sex, low preoperative albumin, anaemia, laparoscopic conversion and simultaneous colonic resection were associated with an increased likelihood of requiring a stoma and were used to develop an SS. The calculator is available online at https://rebrand.ly/CrohnsStoma .

Perioperative outcomes of minimally invasive ileocolic resection for complicated Crohn disease: Results from a referral center retrospective cohort

BackgroundMinimally invasive ileocolic resection for complicated Crohn disease, defined as penetrating Crohn disease associated with intra-abdominal fistula, abscess, or phlegmon, is challenging. In addition, the impact of the minimally invasive approach on postoperative outcomes is still debated. This study aimed to compare the intraoperative and postoperative outcomes of minimally invasive ileocolic resection for complicated versus uncomplicated Crohn disease. MethodsA retrospective analysis of all consecutive adult patients with Crohn disease undergoing minimally invasive ileocolic resection from 2014 to 2021 was performed. Perioperative outcomes were compared between patients with complicated Crohn disease (complicated group) and patients without these lesions (uncomplicated group). ResultsAmong the 274 patients undergoing minimally invasive ileocolic resection for Crohn disease, 101 (36.9%) had a robotic approach, and 84 (30.7%) had complicated Crohn disease. Complicated patients were more frequently malnourished (32.1% vs 16.1%, P = .004) and had more frequent previous bowel resections for Crohn disease (22.1% vs 9.5%, P = .002). There were no differences between both groups regarding intraoperative complications (1.1% uncomplicated group vs 2.4% complicated group, P = .463), conversion rate (2.6% uncomplicated group vs 4.8% complicated group, P = .463), postoperative morbidity (27.4% uncomplicated group vs 34.5% complicated group, P = .231), intra-abdominal septic complications (4.2% uncomplicated group vs 7.1% complicated group, P = .309), and length of stay (3.8 ± 2.0 days uncomplicated group vs 4.2 ± 3.0 complicated group, P = .188). ConclusionMinimally invasive ileocolic resection for complicated Crohn disease is safe and feasible. Future prospective studies are needed to confirm these results.

Ileocolic Resection for Crohn Disease: The Influence of Different Surgical Techniques on Perioperative Outcomes, Recurrence Rates, and Endoscopic Surveillance.

Ileocolic resection (ICR) is the most common surgical procedure in Crohn disease (CD). There are many surgical techniques for performing ICRs and subsequent anastomoses. Recurrence of CD after ICR is common, often clinically silent, and thus requires monitoring including periodic use of endoscopy to detect early active disease. There is emerging evidence that surgical approaches may influence CD recurrence. This review explores the various surgical considerations, the data behind each decision, and how these techniques influence subsequent endoscopic surveillance.

A scoring system to predict a prolonged length of stay after surgery for Crohn's disease.

Many factors influence the postoperative length of stay (LOS) in Crohn's disease (CD). This study aims to identify the factors associated with a prolonged LOS after ileocolic resection (ICR) for CD and to develop a scoring system to predict the postoperative LOS in CD. Patient data were collected from St Marks Hospital, London, UK, and the Humanitas Clinical and Research Center Milan, Italy, for all patients who underwent an ICR for CD from 2005 to 2017. Logistic regression was used for multivariate analysis. The scoring system was developed from the logistic regression model. The performance of the scoring system was evaluated using the area under the receiver operating characteristic curve (AUROC). A total of 628 surgeries were included in the analysis. Eighty eight surgeries were excluded due to missing data. The remaining 543 were divided into two cohorts for the development (n=418) and validation (n=125) of the scoring system. The regression model was statistically significant (p<0.0001). The statistically significant independent variables included the time since diagnosis, American Society of Anesthesiologists (ASA) grade, perioperative use of steroids, surgical access, strictureplasty and platelet count. The AUROCs for the development and validation cohorts were 0.732 and 0.7, respectively (p<0.0001). The cut-off score suggested by Youden's index was 50, with a sensitivity of 65.6% and a specificity of 73.3%. The time since diagnosis, ASA grade, steroid use, surgical access, strictureplasty and platelet count were associated with a prolonged LOS and were used to develop a scoring system. The calculator is available online at https://rebrand.ly/Crohnscal.

P015 ILEOCOLIC RESECTION FOR CROHN’S DISEASE: CURRENT TRENDS FROM ANALYSIS OF 2 YEARS OF NSQIP IBD COLLABORATIVE DATA

Ileocolic resection (ICR) is performed for Crohn's disease (CD) patients with terminal ileitis requiring surgery. Current National Surgical Quality Improvement Program (NSQIP) data is lacking specificity around IBD surgery, including stoma formation and biologic therapies. The NSQIP IBD Collaborative (NSQIP-IBD) is a multicenter working group formed to better collect and analyze perioperative data unique to IBD patients under the auspices of NSQIP. We present retrospective analysis of a multicenter cohort of ICR for CD to describe the current practice of ICR for CD across our collaborative and explore factors associated with rates of postoperative complications on behalf of NSQIP-IBD.

Su1384 Medical Prophylaxis After Ileocolic Resection for Crohn's Disease – No Need to Rush

Background: Crohn's disease (CD) most commonly affects the terminal ileum, with a majority of patients ultimately requiring ileocolic resection. Histologic and immunologic evidence suggests that mucosal inflammation occurs early after exposure of the neoterminal ileum to autologous luminal contents. Therefore, early medical prophylaxis has been advocated to prevent endoscopic recurrence of CD. The purpose of this study was to evaluate whether the timing of medical prophylaxis after ileocolic resection affects endoscopic recurrence of CD. Methods: A single institution, prospectively maintained database was queried for CD patients undergoing ileocolic resection over a 13-year period ending January 2013. Patients were included if they underwent postoperative endoscopy within 12-months of surgery and were started on medical therapy using 5-aminosalicylates (5ASA), immunomodulators, or biologic agents prior to their first postoperative endoscopy. Patients were divided into two groups; those started on medical prophylaxis within 4 weeks of surgery (Early) and those who receivedmedical prophylaxis 4 weeks or more after surgery (Late). The primary endpoint was endoscopic recurrence (defined as a Rutgeerts' endoscopic score of i2, i3, or i4 at first postoperative endoscopy). Secondary endpoints included time to endoscopic recurrence, and any radiological, clinical and surgical recurrence. Results: The 165 study patients had a mean age (SD) of 32.2 (14.6) years and 91 (55%) were male (Table). Mean time to starting medical therapy was 3.8 (2) weeks. 99 patients (60%) were in the Early prophylaxis group and 65 (40%) were in the Late prophylaxis group. Compared to the Early prophylaxis group, the Late prophylaxis group was treated more commonly with biologics (p<0.001) and less commonly with 5-ASA (p=0.007) or immunomodulators (p=0.004). At a mean endoscopy time of 6.8 (2.4) months, 65 patients (39%) had endoscopic recurrence; 39 (39%) in the Early group and 26 (39%) in the Late group. There was also no significant difference in clinical or surgical recurrence between the Early versus Late prophylaxis patient groups. Subgroups analysis of patients treated postoperatively with non-biologic medical prophylaxis, biologic alone, or biologic with other agents, showed no significant difference in endoscopic recurrence between Early and Late prophylaxis patient groups. Conclusion: Althoughmedical prophylaxis after ileocolic resection for CD has been shown to reduce endoscopic recurrence, it may be safe to wait until patients are out of the initial perioperative period prior to initiating medical prophylaxis without any adverse effects on endoscopic recurrence.

Stapled Side-to-Side Anastomosis Might Be Better Than Handsewn End-to-End Anastomosis in Ileocolic Resection for Crohn’s Disease: A Meta-Analysis

Ileocolic anastomosis is an essential step in the treatment to restore continuity of the gastrointestinal tract following ileocolic resection in patients with Crohn's disease (CD). However, the association between anastomotic type and surgical outcome is controversial. The aim of this meta-analysis is to compare surgical outcomes between stapled side-to-side anastomosis (SSSA) and handsewn end-to-end anastomosis (HEEA) after ileocolic resection in patients with CD. Studies comparing SSSA with HEEA after ileocolic resection in patients with CD were identified in PubMed and EMBASE. Outcomes such as complication, recurrence, and re-operation were evaluated. Eight studies (three randomized controlled trials, one prospective non-randomized trial, and four non-randomized retrospective trials) comparing SSSA (396 cases) and HEEA (425 cases) were included. As compared with HEEA, SSSA was superior in terms of overall postoperative complications [odds ratio (OR), 0.54; 95 % confidence interval (CI) 0.32-0.93], anastomotic leak (OR 0.45; 95 % CI 0.20-1.00), recurrence (OR 0.20; 95 % CI 0.07-0.55), and re-operation for recurrence (OR 0.18; 95 % CI 0.07-0.45). Postoperative hospital stay, mortality, and complications other than anastomotic leak were comparable. Based on the results of our meta-analysis, SSSA would appear to be the preferred procedure after ileocolic resection for CD, with reduced overall postoperative complications, especially anastomotic leak, and a decreased recurrence and re-operation rate.

Laparoscopic‐Assisted Versus Open Ileocolic Resection for Adolescent Crohn Disease

ABSTRACTBackgroundLaparoscopic‐assisted ileocolic resection for Crohn disease has been reported as an acceptable alternative to the open procedure in adults. We evaluated our experience with this procedure in the adolescent population.MethodsAll adolescents undergoing ileocolic resection for Crohn disease during a 3‐year period were retrospectively reviewed. Intraoperative and early postoperative results were analyzed, comparing those undergoing the laparoscopic‐assisted approach with those having open resection.ResultsEleven patients (mean age, 15.6 years) underwent open and 12 patients (mean age, 16.5 years) underwent laparoscopic‐assisted resection. None had undergone previous resection. The two groups did not differ with respect to time from diagnosis to surgery, indications for surgery, preoperative medical therapy, operative time, or length of intestine resected. One patient in the laparoscopic‐assisted group was converted to an open procedure. There were no intraoperative complications in either group. Although no statistically significant differences were noted for number of days on narcotic, total dosage of narcotic, and time to regular diet, patients undergoing laparoscopic‐assisted resection were discharged 2.2 days earlier (5.4 vs. 7.6;P &lt; 0.05). There was one wound infection and one intraabdominal abscess in the open resection group, and a single patient in the laparoscopic‐assisted group with postoperative fever and a wound infection.ConclusionsLaparoscopic‐assisted ileocolic resection is a safe alternative to open surgery in adolescent patients with Crohn disease.

Laparoscopic-assisted versus open ileocolic resection for adolescent Crohn disease.

Laparoscopic-assisted ileocolic resection for Crohn disease has been reported as an acceptable alternative to the open procedure in adults. We evaluated our experience with this procedure in the adolescent population. All adolescents undergoing ileocolic resection for Crohn disease during a 3-year period were retrospectively reviewed. Intraoperative and early postoperative results were analyzed, comparing those undergoing the laparoscopic-assisted approach with those having open resection. Eleven patients (mean age, 15.6 years) underwent open and 12 patients (mean age, 16.5 years) underwent laparoscopic-assisted resection. None had undergone previous resection. The two groups did not differ with respect to time from diagnosis to surgery, indications for surgery, preoperative medical therapy, operative time, or length of intestine resected. One patient in the laparoscopic-assisted group was converted to an open procedure. There were no intraoperative complications in either group. Although no statistically significant differences were noted for number of days on narcotic, total dosage of narcotic, and time to regular diet, patients undergoing laparoscopic-assisted resection were discharged 2.2 days earlier (5.4 vs. 7.6; P < 0.05). There was one wound infection and one intraabdominal abscess in the open resection group, and a single patient in the laparoscopic-assisted group with postoperative fever and a wound infection. Laparoscopic-assisted ileocolic resection is a safe alternative to open surgery in adolescent patients with Crohn disease.

Risk Factors of Complications After Ileocolic Resection for Crohn Disease According to the Comprehensive Complication Index

Risk Factors of Complications After Ileocolic Resection for Crohn Disease According to the Comprehensive Complication Index