Preoperative management is more important than choice of sutured or stapled anastomosis in Crohn's disease

Objective: To find out if there were any differences in postoperative complications and anastomotic leak rate between sutured and stapled anastomoses after bowel resection in patients exposed to the same preoperative management programme. Design: Prospective observational non-randomised study. Setting: Colorectal unit. Sweden. Patients: Between 1996 and 2000 bowel resections with anastomosis were done for 42 consecutive patients with Crohn's disease, 20 patients had their anastomoses sutured (sutured group) and 22 had their anastomosis stapled (stapled group) over two successive periods. Main outcome measures: Postoperative complications and anastomotic leak rate. Results: None of the patients were on immunosuppressive treatment and about half in each group had had several weeks of preoperative enteral nutrition. No anastomotic-related complications and few other postoperative complications were noted, irrespective of the anastomotic technique used. Conclusion: A strategy to operate on Crohn patients without steroids and. if indicated. treated preoperatively with enteral nutrition and percutaneous drainage of abscesses resulted in no anastomotic leaks and few postoperative complications. These results were independent of the anastomotic technique used.