Abstract Background Ileocolic resection is the most common surgical procedure in patients with Crohn’s disease (CD). While various anastomotic techniques are used, data on their long-term outcomes remain limited. The purpose of this study was to compare the long-term disease outcomes between isoperistaltic side-to-side stabled anastomosis (IPSSA) and antiperistaltic side-to-side stabled anastomosis (APSSA) in patients with CD. Methods Data for this observational study were collected from patients at our tertiary referral center between March 2019 and March 2025. Patients with CD who underwent first-time surgery with isoperistaltic or antiperistaltic side-to-side stapled anastomosis were included in the study. The study excluded patients with stomas and those with other types of anastomoses. We compared the composite long-term outcomes of endoscopic activation (Rutgeerts ≥ i2), and CD-related re-surgery Results A total 358 CD patients were reviewed. After matching, 128 patients (median age at onset: 29 years, 60.9% male) remained in each group with well-balanced baseline characteristics. 69 patients (53.9%) had IPSSA (median age at onset: 31 years, 59.4% male, total disease duration: 10.8 years) and 59 patients (46.1%) had APSSA (median age at onset: 28 years, 62.7% male, total disease duration: 11.8 years). Penetrating behavior was more common in the APSSA (54.2%) than IPSSA (37.7%) group (p = 0.036). Although active smokers were more common in the IPSSA (33.3%) than APSSA (15.3%) group (p = 0.002). There were no significant differences between the two groups in terms of the age, gender, family history of inflammatory bowel disease, perianal disease, extra intestinal manifestations, prior immunomodulatory or biologic drugs, hemoglobin, albumin and Crohn’s Disease Activity Index score at baseline (p 0.05). Overall, the median follow-up time was 6.3 and 5.1 years after creating the first IPSSA and APSSA group, respectively (p 0.05). There was no significant difference between IPSSA and APSSA in the frequency of Rutgeerts score ≥ i2 (60.9% versus 64.4%, respectively) or CD-related re-surgery (4.3% versus 13.6%, respectively) (p 0.05). There were also no significant differences in the rate of prophylactic biologic therapy or biologic switch needed between the two groups (p 0.05). Conclusion In this study, our results revealed comparable long-term postoperative recurrence between IPSSA and APSSA in patients with CD. Further research with a large group and longer follow-up is essential among different anastomotic constructions. Conflict of interest: Ergul, Mucahit: No conflict of interest Aksoy, Erol: No conflict of interest Ozturk, Oguz: No conflict of interest Atay, Ali: No conflict of interest Cagir, Yavuz: No conflict of interest Coskun, Orhan: No conflict of interest Hamamci, Mevlut: No conflict of interest Tenlik, Ilyas: No conflict of interest Acun, Kadir: No conflict of interest Keskin, Emir Tugrul: No conflict of interest Yilmaz, Eren: No conflict of interest Durak, Muhammed Bahaddin: No conflict of interest Kilic, Zeki Mesut Yalin: No conflict of interest Bostanci, Erdal Birol: No conflict of interest Prof. Dr. Yuksel, Ilhami: No conflict of interest
Ergül et al. (Thu,) studied this question.