High complication rate in Crohn’s disease surgery following percutaneous drainage of intra-abdominal abscess: a multicentre study
Authors: Celentano Valerio , Giglio Mariano Cesare , Pellino Gianluca , Rottoli Matteo , Sampietro Gianluca , Spinelli Antonino , Selvaggi Francesco ,   on behalf of the Italian Society of Colorectal Surgery SICCR, Celentano Valerio , Pellino Gianluca , Rottoli Matteo , Poggioli Gilberto , Sica Giuseppe , Giglio Mariano Cesare , Campanelli Michela , Coco Claudio , Rizzo Gianluca , Sionne Francesco , Colombo Francesco , Sampietro Gianluca , Lamperti Giulia , Foschi Diego , Ficari Ferdinando , Vacca Ludovica , Cricchio Marta , Giudici Francesco , Selvaggi Lucio , Sciaudone Guido , Peltrini Roberto , Manfreda Andrea , Bucci Luigi , Galleano Raffaele , Ghazouani Omar , Zorcolo Luigi , Deidda Simona , Restivo Angelo , Braini Andrea , Di Candido Francesca , Sacchi Matteo , Carvello Michele , Martorana Stefania , Bordignon Giovanni , Angriman Imerio , Variola Angela , Di Ruscio Mirko , Barugola Giuliano , Geccherle Andrea , Tropeano Francesca Paola , Luglio Gaetano , Tanzanu Marta , Sasia Diego , Migliore Marco , Giuffrida Maria Carmela , Marrano Enrico , Moretto Gianluigi , Impellizzeri Harmony , Gallo Gaetano , Vescio Giuseppina , Sammarco Giuseppe , Terrosu Giovanni , Calini Giacomo , Bondurri Andrea , Maffioli MD Anna , Zaffaroni Gloria , Resegotti Andrea , Mistrangelo Massimiliano , Allaix Marco Ettore , Botti Fiorenzo , Prati Matteo , Boni Luigi , Perotti Serena , Mineccia Michela , Giuliani Antonio , Romano Lucia , Graziano Giorgio Maria Paolo , Pugliese Luigi , Pietrabissa Andrea , Delaini Gian Gaetano , Spinelli Antonino , Selvaggi Francesco 
Published: May 2022

Abstract
Introduction
Intra-abdominal abscesses complicating Crohn’s disease (CD) present an additional challenge as their presence can contraindicate immunosuppressive treatment whilst emergency surgery is associated with high stoma rate and complications. Treatment options include a conservative approach, percutaneous drainage, and surgical intervention. The current multicentre study audited the short-term outcomes of patients who underwent preoperative radiological drainage of intra-abdominal abscesses up to 6 weeks prior to surgery for ileocolonic CD.

Methods
This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing ileocolic resection for primary or recurrent CD from June 2018 to May 2019. The outcomes of patients who underwent radiological guided drainage prior to ileocolonic resection were compared to the patients who did not require preoperative drainage. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes.

Results
Amongst a group of 575 included patients who had an ileocolic resection for CD, there were 36 patients (6.2%) who underwent abscess drainage prior to surgery. Postoperative morbidity (44.4%) and anastomotic leak (11.1%) were significantly higher in the group of patients who underwent preoperative drainage.

Conclusions
Patients with Crohn’s disease who require preoperative radiological guided drainage of intra-abdominal abscesses are at increased risk of postoperative morbidity and septic complications following ileocaecal or re-do ileocolic resection.