New anti-mesenteric delta-shaped stapled anastomosis: Technical report with short-term postoperative outcomes in patients with Crohn’s disease

Table 1 Baseline characteristics between the new anti-mesenteric side-to-side delta-shaped stapled anastomosis and the conventional side-to-side stapled anastomosis groups

Variables	Delta-shaped	Conventional	P value	SMD1	Delta-shaped	Conventional	SMD1
	n = 92	n = 83			n = 92	n = 83
Age at diagnosis, years, mean ± SD	26.87 ± 9.25	28.10 ± 10.57	0.414	0.123	27.9 ± 9.29	27.53 ± 11.46	0.036
Age at operation, years, mean ± SD	35.22 ± 10.01	34.37 ± 11.47	0.604	0.078	34.88 ± 9.89	34.64 ± 11.51	0.022
Sex, n (%)			0.607	0.095			0.019
Female	26 (28.3)	20 (24.1)			22 (24.3)	19 (23.5)
Male	66 (71.7)	63 (75.9)			70 (75.7)	64 (76.5)
Body mass index at operation, kg/m2, mean ± SD	19.56 ± 3.10	20.12 ± 3.54	0.261	0.170	20.09 ± 3.43	19.82 ± 3.51	0.078
History of previous abdominal operation, n (%)			0.198	0.195			0.042
Yes	27 (29.3)	32 (38.6)			33 (36.4)	29 (34.4)
History of perianal fistula, n (%)			0.645	0.145			0.075
None	63 (68.5)	62 (74.7)			68 (74.2)	64 (77.3)
Currently having perianal fistula	5 (5.4)	3 (3.6)			4 (4.4)	3 (3.8)
Healed state after treatment	24 (26.1)	18 (21.7)			20 (21.4)	16 (18.9)
Family history of CD, n (%)			0.709	0.079			0.025
Yes	3 (3.3)	4 (4.8)			3 (3.3)	3 (3.8)
History of smoking, n (%)			0.236	0.259			0.093
None	53 (57.6)	49 (59.0)			51 (55.6)	49 (59.3)
Ex-smoker	26 (28.3)	16 (19.3)			21 (22.6)	19 (22.4)
Current smoker	13 (14.1)	18 (21.7)			20 (21.8)	15 (18.3)
Montreal classification behavior, n (%)			0.779	0.108			0.118
Non-stricturing, non-penetrating (B1)	12 (13.0)	8 (9.6)			10 (11.3)	12 (14.4)
Stricturing (B2)	31 (33.7)	29 (34.9)			34 (37.3)	27 (32.7)
Penetrating (B3)	49 (53.3)	46 (55.4)			47 (51.4)	44 (52.9)
Montreal classification location, n (%)			0.021a	0.439			0.041
Ileum (L1)	46 (50.0)	45 (54.2)			45 (49.1)	42 (51.1)
Colon (L2)	13 (14.1)	2 (2.4)			8 (8.2)	6 (7.7)
Ileocolon (L3)	33 (35.9)	36 (43.4)			39 (42.7)	34 (41.2)
Medical treatment just before surgery, n (%)
No medication	23 (25.0)	17 (20.5)	0.477	0.108	20 (21.8)	19 (22.3)	0.013
Immunomodulators, only	27 (29.3)	34 (41.0)	0.107	0.245	33 (35.9)	28 (33.8)	0.043
Anti-TNF-α antibodies, only	21 (22.8)	14 (16.9)	0.325	0.150	18 (19.3)	16 (19.0)	0.006
Corticosteroids, only	5 (5.4)	7 (8.4)	0.433	0.118	6 (6.2)	6 (6.6)	0.018
Combined immunomodulators with anti-TNF-α antibodies	10 (10.9)	10 (12.0)	0.807	0.037	11 (12.1)	12 (14.6)	0.073
Combined immunomodulators with corticosteroids	5 (5.4)	2 (2.4)	0.448	0.156	4 (4.1)	3 (3.6)	0.028
Combined anti-TNF-α antibodies with corticosteroids	2 (2.2)	1 (1.2)	> 0.999	0.075	1 (1.6)	1 (1.2)	0.032

^aP < 0.05.

¹Standardized mean difference: (1) Discrimination: c-statistics = 0.722; and (2) Calibration: Hosmer-Lemeshow statistics: χ² = 4.0785; df = 8; P value = 0.85.

CD: Crohn’s disease; TNF: Tumor necrosis factor; SMD: Standardized mean difference.

Table 2 Operative findings between the delta-shaped stapled anastomosis and conventional side-to-side stapled anastomosis groups

Variables	Delta-shaped	Conventional	Before IPTW	After IPTW
	n = 92	n = 83	P value	P value
Operative indication, n (%)			0.185	0.411
Stricture or obstruction	12 (13.0)	5 (6.0)
Fistula (enteric-) or abscess	78 (84.8)	75 (90.4)
Perforation (peritonitis)	2 (2.2)	1 (1.2)
Bleeding	0 (0)	2 (2.4)
Emergency operation, n (%)			0.425	0.430
Yes	2 (2.2)	4 (4.8)
Operative approach, n (%)			0.852	0.829
Open	18 (19.6)	18 (21.7)
Laparoscopy	74 (80.4)	65 (78.3)
Operative name, n (%)			0.425	0.160
Ileocecal resection	28 (30.4)	25 (30.1)
Right hemicolectomy	26 (28.3)	17 (20.5)
Small bowel resection and anastomosis	38 (41.3)	41 (49.4)
Number of anastomosis, n (%)			0.682	0.810
1	76 (82.6)	71 (85.5)
2	16 (17.4)	12 (14.5)

IPTW: Inverse-probability-of-treatment weighted.

Table 3 Postoperative outcomes between the delta-shaped stapled anastomosis and conventional side-to-side stapled anastomosis groups

Variables	Delta-shaped	Conventional	Before IPTW	After IPTW
	n = 92	n = 83	P value	P value
Hospital stay after surgery, days, mean ± SD	5.67 ± 1.53	7.39 ± 3.69	< 0.001a	< 0.001a
Operation time, minutes, mean ± SD	107.23 ± 25.16	112.54 ± 28.48	0.192	0.480
Intraoperative blood loss, n (%)			0.075	0.031a
< 10 mL	64 (69.6)	44 (53.0)
10-200 mL	26 (28.3)	35 (42.2)
> 200 mL	2 (2.2)	4 (4.8)
Transfusion after surgery, n (%)			0.104	0.054
Yes	8 (8.7)	14 (16.9)
No	84 (91.3)	119 (82.1)
Number of pack RBC after surgery, mean ± SD	0.16 ± 0.72	0.35 ± 0.88	0.123	0.175
Postoperative complications, n (%)	15 (16.3)	27 (32.5)	0.014a	0.002a
Number of complication, n (%)			0.037a	0.002a
0	78 (84.8)	58 (69.9)
1	13 (14.1)	20 (24.1)
2	1 (1.1)	5 (6.0)
Clavien-Dindo classification, n (%)			0.021a	0.006a
II	11 (12.0)	21 (25.3)
IIIa	4 (4.3)	3 (3.6)
IIIb	0 (0.0)	3 (3.6)
Infectious complications, n (%)	10 (10.9)	13 (15.7)
Wound	5 (5.4)	5 (6.0)	> 0.999	0.964
Intra-abdominal abscess	4 (4.3)	4 (4.8)	> 0.999	0.603
Anastomotic leakage	0 (0.0)	1 (1.2)	0.474	0.255
Other infectious complication1	1 (1.1)	2 (2.4)	0.604	0.432
Non-infectious complications, n (%)
Ileus	4 (4.3)	12 (14.5)	0.033a	0.022a
Bleeding	1 (1.1)	3 (3.6)	0.347	0.031a
Other2	0 (0)	1 (1.2)	0.474	0.314
Surgical recurrence, n (%)			0.224	0.137
Yes	0 (0)	2 (2.4)

^aP < 0.05.

¹Other infectious complication includes Clostrium difficile infection and urinary tract infection.

²Other complication includes portal vein thromobosis after surgery.

IPTW: Inverse-probability-of-treatment weighted.

Table 4 Logistic regression analysis for overall postoperative complication

Overall complication		No	Yes	Logistic regression analysis
Model	Anastomosis			OR	95%CI		P value
Crude model
	Conventional, n (%)	56 (64.5)	27 (32.5)	1
	Delta, n (%)	77 (83.7)	15 (16.3)	0.404	0.197	0.829	0.014a,2
Weighted model with IPTW1
	Conventional, n (%)	54 (65.1)	29 (34.9)	1
	Delta, n (%)	79 (85.7)	13 (14.3)	0.312	0.149	0.653	0.002a

^aP < 0.05.

¹Inverse-probability-of-treatment weighted, weighted logistic regression model.

²Logistic regression model.

OR: Odds ratio; CI: Confidential interval; IPTW: Inverse-probability-of-treatment weighted.