End-to-Side Ileocolonic Anastomosis after Ileocecectomy for Crohn’s Disease is a Safe Option with Low Recurrence

BACKGROUND: The recent advent of the Kono-S anastomosis has raised the question of the impact of anastomotic configuration on recurrence following ileocecectomy for Crohn's disease. Determining if there is a superior configuration is an opportunity for improvement in optimization in surgical care for Crohn's disease patients. At the University of Chicago, we perform a variety of anastomotic configurations, including side-to-side, end-to-end, end-to-side, side-to-end and Kono-S. OBJECTIVE: Determine if there is a difference in recurrence between anastomotic configurations following ileocecectomy for Crohn's disease at a high volume IBD center. DESIGN: Retrospective chart review. SETTING: The University of Chicago Medical Center. PATIENTS: Two hundred thirty-nine patients who underwent ileocecectomy for Crohn's disease from January 1, 2018, through December 31, 2022. MAIN OUTCOME MEASURES: Endoscopic recurrence rate for each anastomotic configuration. RESULTS: 239 patients with Crohn's disease who underwent ileocecectomy were included. The anastomotic configurations were similar in terms of patient characteristics. The end-to-side anastomoses were associated with lower blood loss and shorter OR times. On multivariable analysis, elective surgery and end-to-side anastomotic configuration were associated with lower recurrence of Crohn's disease at an average follow-up of 32 months. LIMITATIONS: Study is retrospective in nature and conducted at a single institution. CONCLUSIONS: End-to-side anastomosis configuration is a safe, technically easy to perform reconstruction method that may reduce the rate of disease recurrence. See Video Abstract.