Ileorectal anastomosis in patients with Crohn's disease. Postoperative complications and functional outcome-a systematic review.

Baelum, Jens Kristian; Qvist, Niels; Ellebaek, Mark Bremholm

BACKGROUND AND AIMS The objective of this systematic review was to investigate the outcomes of IRA in Crohn´s disease and to clarify whether there are any time-related trends in outcome measures. The primary outcomes are risk of anastomotic leakage, death, clinical recurrence and subsequent diverting or permanent stoma and/or proctectomy. Secondary endpoints are quality of life and functional outcome. METHODS Systematic searches were conducted using the Cochrane library, EMBASE and Medline. The complete search strategy is uploaded online at: http://www.crd.york.ac.uk/prospero/. Human studies in English with over five subjects were included and no limit was set regarding the date of publication. All relevant studies were screened by two reviewers. The web-based software platform www.covidence.org was used for primary screening of the title, abstract, full-text review and data extraction. RESULTS The search identified 2231 unique articles. After the screening process, 37 remained. Key results were an overall anastomotic leak (AL) rate of 6.4%; cumulative rates of clinical recurrence of 43% and 67% at 5 and 10 years, respectively; an overall rate of proctectomy of 18.9%; and subsequent ileostomy required in 18.8%. Only one study presented useful data on quality of life. Recurrence rates remained stable over time. A small decline in the anastomotic leak rate was found. CONCLUSIONS Only minor improvements in the outcomes of IRA in patients with Crohn´s disease have occurred during the past 50 years regarding anastomotic leakage and recurrence, except for a slight increase in the rate of a functioning IRA. These results call for the implementation guidelines in patient selection for IRA, and post-operative medical treatment and follow-up.