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Anti-tumor necrosis factor alpha agents influence postoperative anastomotic complications in Crohn’s

The most recent issue of the Diseases of the Colon & Rectum examines the effect of anti-tumor necrosis factor alpha on postoperative complications in patients with Crohn’s disease undergoing abdominal surgery.

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Patients with Crohn’s disease treated with anti-tumor necrosis factor alpha agents may have an increased risk of surgical complications.

Dr Alaa El-Hussuna assessed the effect of anti-tumor necrosis factor alpha on postoperative complications in patients with Crohn’s disease undergoing abdominal surgery.

Studies were identified through electronic and manual searches.

14 studies were identified
Diseases of the Colon & Rectum

The research team included observational studies on patients with Crohn’s disease undergoing laparoscopic or open abdominal surgery.

Anti-tumor necrosis factor alpha agents were administered within 3 months before surgery.

The team's main outcome was anastomotic complications including overt dehiscence, intra-abdominal abscess, and enteric fistulas.

The researchers included 14 studies on 679 patients in the intervention (anti-tumor necrosis factor alpha) group, and 2363 controls.

Random-effects meta-analysis found no difference in anastomotic complications between the 2 groups.

There was clear heterogeneity between studies.

In subgroup analyses, the anti-tumor necrosis factor alpha increased anastomotic complications in trials with a lower risk of bias, but not in the studies with a higher bias risk.

In the overall analysis and in studies with a lower bias risk, anti-tumor necrosis factor alpha agents increased the risk of nonanastomotic surgical complications, major medical complications, and minor medical complications.

Dr El-Hussuna's team commented, "In studies with a low risk of bias, anti-tumor necrosis factor alpha agents increased the risk of anastomotic complications."

"Inadequate bias control may lead to an underestimated risk of anastomotic complications."

Dis Colon Rectum 2013: 56(12): 1423–1433
21 November 2013

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