Abstract Background Ileocecectomy is one of the most frequently performed surgical procedures for Crohn’s disease (CD). Despite advances in surgical techniques and perioperative management, postoperative disease recurrence remains a major clinical burden, with up to 60% of patients developing endoscopic recurrence within one year of resection. Several risk factors for recurrence have been identified, including disease phenotype and postoperative medical therapy but there is little data on the relationship between postoperative complications and recurrenc Methods A retrospective cohort study that included 242 CD patients who underwent primary ileo-cecal resection and were followed for a period of 48 months (mean) for signs of disease recurrence, at a single high-volume center (RMC) between 01.2015-12.2023 Results Postoperative complications were not associated with an increased risk of clinical, endoscopic or surgical disease recurrence. However, elevated preoperative CRP levels correlated with a shorter time to recurrence (P = 0.02), and postoperative therapy type also affecting recurrence rates: patients who continued their pre-surgery medical therapy or received no therapy had a lower recurrence rate than those who switched to a new medication after surgery (P = 0.005). A longer interval from diagnosis to surgery was associated with a higher complication rate (P = 0.01), and patients who had intraoperative bleeding also developed more postoperative complications (P = 0.04). Preoperative fecal calprotectin level was the only factor found to influence complication severity (Clavien–Dindo grade; P = 0.05).Men experienced significantly more complications than women (P = 0.018). No significant relationships were observed between the occurrence of complications and patient age, albumin level, C-reactive protein (CRP), fecal calprotectin, smoking status, preoperative diet type, or surgical urgency. No preoperative or intraoperative factor was associated with postoperative disease recurrence. Conclusion Postoperative complications were not associated with increased clinical, endoscopic, or surgical recurrence. Recurrence seems primarily driven by the underlying inflammatory burden, as reflected by elevated preoperative CRP levels. Patients who continued prior therapy or required no treatment showed fewer recurrences, which may also reflect the influence of underlying disease biology. Higher fecal calprotectin levels correlated with more severe complications, suggesting that active inflammation at surgery predisposes to a more difficult recovery. Overall, postoperative recurrence appears largely determined by disease biology rather than surgical or perioperative factors References: 1. Rottoli M, Vallicelli C, Giudici F, et al. Risk factors for postoperative recurrence of Crohn’s disease with emphasis on surgical predictors: a review. Ann Gastroenterol. 2020;33(6):583–593. 2. Boschetti G, Laidet M, Moussata D, et al. Levels of fecal calprotectin are associated with endoscopic recurrence in asymptomatic patients after ileocolonic resection for Crohn’s disease. Am J Gastroenterol. 2015;110(6):865–872. Conflict of interest: Dr. Naveh, Hilla: No conflict of interest Slomowitz, Edden: No conflict of interest Wasserberg, Nir: No conflict of interest White, Ian: No conflict of interest
Naveh et al. (Thu,) studied this question.