Abstract Background Ileocolonic resection with ileocolonic anastomosis is the most frequent surgery for Crohn’s disease (CD). Side-to-side anastomosis is currently recommended by European Crohn’s and Colitis Organisation (ECCO) guidelines, and the laparoscopic approach is commonly performed. However, it remains uncertain whether performing the anastomosis intracorporeally or extracorporeally ultimately affects postoperative outcomes. Currently, there is no study comparing postoperative outcomes in intracorporeally and extracorporeally ileocolonic anastomoses in CD. Therefore, our study aimed to fill this gap in the surgical practice. Methods In this observational study, 71 consecutive patients who underwent primary ileocecal resection followed by ileocolonic side-to-side anastomosis in our department from 2020 to 2024 were analysed. The choice of performing the anastomosis intra- or extra-corporeally depended on surgeon’s preferences. For each patient, clinical and surgical record, and outpatient follow-up visits were thoroughly retrieved. Moreover, 54 patients agreed to participate in a telephone interview to assess patients’ clinical disease activity (Harvey-Bradshaw), quality of life (Cleveland Global Quality of Life), and body image (Body Image Questionnaire) after surgery. Non-parametric statistics and survival analysis were performed. Results In our series, 28 and 43 patients underwent intra-corporal and extracorporeal anastomosis after ileocolonic resection, respectively. We did not observe any difference in terms of postoperative complications, operative timing and, disease activity at follow-up. The Body Image Questionnaire (BIQ) results showed that patients who underwent intracorporeal anastomosis were more satisfied with their bodies (BIQ1, p = 0.021), and tended to feel more attractive (BIQ3, p = 0.046), and more masculine/feminine (BIQ4, p = 0.068) compared to those with extracorporeal anastomosis. However, in a median follow-up of 40 months, 3 patients who had an intracorporeal anastomosis had a reoperation for CD recurrence compared to 1 patient in the extracorporeal group (Tarone-Ware test p = 0.058). Conclusion Our study suggests that intracorporeal anastomosis has clear aesthetic advantages compared to extracorporeal anastomosis but, it is associated with a higher risk of reoperation for CD recurrence. Conflict of interest: Rocchi, Silvia: Celotto, Francesco: No conflict of interest Saadeh, Luca: No conflict of interest Ruffolo, Cesare: No conflict of interest Spolverato, Gaya: No conflict of interest Rollo, Elena: No conflict of interest Savarino, Edoardo Vincenzo: Personal Fees: Takeda, Abbvie, MSD, Janssen, Sofar Barberio, Brigida: Brigida Barberio: has served as speaker for Abbvie, Agave, Alfasigma, AGpharma, Johnson & Johnson, Eli Lilly, MSD, Pfizer, Procise, Sofar, Takeda, Unifarco. BB has served as consultant for Abbvie, Eli Lilly, ohnson & Johnson. Zingone, Fabiana: No conflict of interest Angriman, Imerio: No Dr. Scarpa, Marco: No conflict of interest
Rocchi et al. (Thu,) studied this question.