Predictive factors and long-term outcomes of anastomotic leakage closure in Crohn’s disease: a retrospective cohort study

Abstract Background The management of anastomotic leakage (AL) in Crohn’s disease (CD) lacks standardized protocols. Identifying predictors of successful AL closure is crucial for surgeons to select the optimal treatment strategy. This study aimed to identify the predictive factors for AL closure in patients with CD and assess long-term outcomes. Methods CD patients with AL between January 2012 and December 2022 were included in this study. Logistic regression models were used to identify the predictors of AL closure. Kaplan-Meier analysis and Cox regression models were used to evaluate long-term outcomes and risk factors for surgical recurrence. Results Sixty-two patients with AL from 1068 CD patients who underwent bowel surgery were included in the study, of whom 40 (64.5%) achieved AL closure through conservative treatment. Leakage from enteroenteric anastomosis was associated with significantly greater odds of AL closure (odds ratio [OR] = 5.07, p = 0.04), while preoperative use of anti-tumor necrosis factor (anti-TNF) was a risk factor (OR = 0.19, p = 0.03). Patients with AL closed had surgical recurrence rates of 2.5%, 8.3%, 14.7%, and 24.1% at 1, 2, 3, and 5 years, respectively. Maintenance anti-TNF therapy was the only factor associated with a reduced risk of surgical recurrence (hazard ratio [HR] = 0.06, p = 0.009). Conclusions Conservative treatment was a viable option for AL management in CD patients. Patients with leakage from enteroenteric anastomosis and those naïve to anti-TNF therapy had higher AL closure rates. Maintenance anti-TNF therapy was associated with a lower risk of surgical recurrence.