New surgical method reduces complications in recurring Crohn's disease

Crohn's disease is a chronic condition marked by recurrent inflammation throughout the intestine, often requiring surgical intervention for complications like intestinal obstruction, fistulas, abscesses, and severe bleeding. 

Despite significant treatment advancements over the past two decades, 60 to 80 percent of Crohn’s disease patients will require major intestinal surgery in their lifetime, with 25 percent facing repeat operations, caught in a relentless cycle of complications and ongoing care.

At Asan Medical Center, Professors Yoon Yong-sik and Lee Jong-lyul of colorectal and rectal surgery have developed a new surgical technique aimed at addressing these challenges by altering the direction of anastomosis—the procedure used to reconnect severed sections of the intestine.

Results indicate that this approach has halved the complication rate and reduced the incidence of intestinal obstruction by over two-thirds compared to traditional methods, suggesting a significant improvement in patient outcomes and quality of life.

Standard Crohn's disease surgery typically involves cutting and suturing sections of the intestine, with surgeons favoring stapled anastomoses over traditional sutures. The stapled technique minimizes tissue damage, shortens surgery time, and reduces the physical strain on patients. However, conventional stapled anastomosis (CSA) presents challenges. By cutting the end of the intestine horizontally, this method can lead to pouch-like bulges, increasing the risk of inflammation and recurrence due to the buildup of food or waste.

In response to these limitations, Professors Yoon and Lee introduced the delta-shaped anastomosis (DSA). This innovative technique reverses the direction of the anastomosis, connecting the intestine vertically at a 90-degree angle instead of horizontally. The result is an intestinal connection resembling the Greek letter delta (Δ), which is wider than in traditional surgery. This design facilitates a smoother passage of intestinal contents, significantly reducing the likelihood of pockets forming that could harbor food and feces, thereby lowering inflammation and recurrence rates.

Professors Yoon and Lee conducted a thorough analysis of 175 Crohn's disease patients who underwent small and large bowel resections at Asan Medical Center in Seoul from 2020 to 2023, with an average follow-up of 20.7 months. Among these patients, 92 received the new DSA method, while 83 underwent the traditional CSA  technique.

The results showed that the complication rate within 30 days post-surgery was 16.3 percent in the DSA group, nearly half the 32.5 percent seen in the CSA group. Intestinal obstruction occurred in just 4.3 percent of patients who had the DSA method, a reduction of more than two-thirds compared to 14.5 percent in the CSA group. Additionally, patients in the DSA group had an average hospital stay of 5.67 days, significantly shorter than the 7.39 days for those in the CSA group, indicating a faster recovery.

The study also revealed improved outcomes regarding intra-abdominal hematoma and postoperative bleeding among patients who underwent the DSA procedure. 

“This study confirms that the new Crohn's disease anastomosis effectively reduces postoperative complications and improves patient recovery compared to conventional techniques,” said Professor Yoon. “We expect this technique to play an important role in improving the quality of life of Crohn's disease patients after surgery.” 

The findings, which highlight the DSA method's reduction in complications and bowel obstructions, were published in the World Journal of Gastrointestinal Surgery on Aug. 27.