Does preoperative anti‑TNF exposure increase the risk of postoperative anastomotic leak compared with preoperative integrin antagonists such as vedolizumab

What is known

- Head-to-head comparisons do not show that preoperative anti-TNF exposure increases anastomotic leak relative to vedolizumab; the largest matched and meta-analytic comparisons find no difference in overall or infectious complications between the two agents. ^1,2

What is unknown / caveats

- Whether anti-TNF itself raises leak/pelvic-sepsis risk (versus no biologic) remains genuinely controversial: the two largest single-centre IPAA series and the largest UC meta-analysis report significantly increased anastomotic leak and pelvic sepsis after anti-TNF, while multiple other series and the prospective PUCCINI data show no association. ^3–6

## References

1. Kim JY, Zaghiyan K, Lightner A, Fleshner P. Risk of postoperative complications among ulcerative colitis patients treated preoperatively with vedolizumab: a matched case-control study. BMC Surg. 2020;20:46. PMID: 32138717.

2. Kann Brian R. Anastomotic Considerations in Crohn's Disease. Clin Colon Rectal Surg. 2023;36(1):63-73. PMID: 36619281.

3. Holubar SD, Lightner AL, Poylin V, Vogel JD, Gaertner W, Davis B, Davis KG, Mahadevan U, Shah SA, Kane SV, Steele SR, Paquette IM, Feingold DL, Prepared on behalf of the Clinical Practice Guidelines Committee of the American Society of Colon and Rectal S. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis. Dis Colon Rectum. 2021;64:783-804. PMID: 33853087.

4. McKenna NP, Lightner AL. Preoperative Considerations in Inflammatory Bowel Disease. Surg Clin North Am. 2019;99(6):1083-1094. PMID: 31676049.

5. Lightner AL, Vaidya P, Holubar S, Warusavitarne J, Sahnan K, Carrano FM, Spinelli A, Zaghiyan K, Fleshner PR. Perioperative safety of tofacitinib in surgical ulcerative colitis patients. Colorectal Dis. 2021;23:2085-2090. PMID: 33942470.

6. Shen B, Blake A, Lasch K, Smyth M, Bhayat F. Vedolizumab use in patients with inflammatory bowel diseases undergoing surgery: clinical trials and post-marketing experience. Gastroenterol Rep (Oxf). 2019;7(5):322-330. PMID: 31687151.

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_Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._