P0899Training Opportunities in Surgery for Crohn’s disease: Outcomes of Resident-Performed Laparoscopic Ileocolic Resections

Abstract Background Surgical training in laparoscopic colorectal surgery remains challenging due to structural and organizational barriers, often limiting independent operative experience for residents. Primary ileocolic resections for Crohn’s disease offer a reproducible setting for competency-based training. This retrospective study aimed to assess perioperative outcomes and training practices of resident-performed Crohn’s resections in a German IBD specialty center. Methods All bowel resections for Crohn’s disease performed from October 2021 to August 2025 at a single academic center were retrospectively reviewed. Exclusions were stoma operations and cases with malignancy. Demographic parameters, Montreal classification, medical and surgical history, operative details (including anastomosis technique, approach, emergency/elective status), and management details (prehabilitation, immunosuppression) were collected. “Resident-performed” defined cases where the full procedure was carried out by a surgical resident under consultant supervision. The primary endpoint was intra-abdominal septic complications (IASC: anastomosis leak, intra-abdominal abscess, peritonitis, fistulas), assessed along with overall and anastomosis-specific morbidity and length of stay (LOS). Risk factors for IASC were evaluated in univariate and multivariate regression. Results A total of 361 Crohn’s resections were analyzed (249 ileocolic, 54 small bowel, 78 colorectum), performed in 284 patients (55% female, mean age 44 years, 41% prior abdominal surgery). Laparoscopic approach was used in 75%. Resident-performed cases (n = 90, 25%) increased annually (from 14% in 2021 to 38.5% in 2025). Residents operated more often on non-penetrating, non-operated patients and on ileocolic cases. Operations by residents demonstrated a lower IASC rate (1% vs. 10%, p = 0.003) and fewer anastomosis-related events (1% vs. 7%, p = 0.046) than those by attending surgeons, while mortality and overall complications showed no increase. Multivariate analysis identified non-ileocolic surgery (HR 3.23, 95%CI 1.2–8.6) and preoperative weight loss 5% (HR 2.8, 95%CI 1.01–7.9) as independent risk factors for IASC. The median postoperative LOS was 6 days. Conclusion Primary ileocolic resections for Crohn’s disease—when performed in a structured, supervised setting—are safe, feasible educational procedures yielding low morbidity. Stepwise allocation of surgical autonomy and targeted case selection facilitate the integration of these operations as foundational elements in colorectal surgical training curricula. Conflict of interest: Ms. Schmitz, Aline: No conflict of interest Iesalnieks, Igors: Personal Fees: In the past, I received speaker’s fees from AbbVie, Takeda, Ethicon and Jansson, Lilly, Galapagos