Risk factors for anastomotic complications after elective intestinal resection in Crohn's disease

Anastomotic leaks are the most feared complications after surgery in patients with Crohn's disease. Identifying associated risk factors is crucial for prevention. We aimed to evaluate possible risk factors for anastomotic complications in our case series.

This was a single-center, retrospective, observational study. Eighty-six patients who underwent intestinal resection due to Crohn's disease at the Department of General Surgery, Marmara University, Faculty of Medicine, from 2015 to 2023 were enrolled. Adult patients of either sex who are over 18 years old were included. Cases, where the anastomosis was defunctioned with a proximal diverting ileostomy or colostomy were excluded from the study.

The mean (StD) age was 34.8 (14.4) years, and 50 patients (58.1%) were male. Twenty-five patients had post-operative complications (29.1%), and 10 of them (11.6%) were above grade three according to the Clavien-Dindo classification. Anastomotic leakage was observed in two, intra-abdominal collection in two, sepsis in two, enterocutaneous fistula in three, and ileus in the remaining one. While the albumin value <3 gr/dL (OR 5.15, p<0.03) and pre-operative medical treatment (OR= 4.79; p= 0.05) were associated with higher odds of post-operative overall complications, only hypoalbuminemia 3 g/dL (OR= 14.3; p= 0.04) was associated with a higher probability of post-operative anastomotic/septic complications.

In patients with pre-operative hypoalbuminemia, temporary stoma creation should be considered due to the potential increased risk of high anastomotic complications. The medical treatments should be discontinued in the pre-operative period due to the increased risk of complications.