Long-term Result of Surgical Treatment for Crohn's Enteritis

Choi, Sang Ji; Choe, Eun Kyung; Park, Sung Chan; Park, Kyu Joo

Abstract

PURPOSE: We sought to determine the long-term outcome of surgical management for gastrointestinal Crohns's disease (CD) and to find out whether there is any improvement over the time period.
METHODS
We analyzed the records of the 102 patients who underwent surgery for gastrointestinal CD excluding perianal CDbetween 1978 and 2007. A cumulative surgical recurrence rate was analyzed by Kaplan-Meier plots and log-rank tests.
RESULTS
The main sites of CD were ileocecal area in 54.5%, followed by small bowel (29.7%) and large bowel (7.9%). Common indications for operation were obstruction (25.7%), diagnostic purpose (20.8%), and failure of medical treatment (12.9%). The operation performed were ileocolectomy including right hemicolectomy in 53 cases (45.3%), small bowel resection in 38 cases (31.7%), and strictureplasty 12 cases (10.0%, including 11 cases combined with bowel resection). The average follow-up period after operation was 6.4years (range: 0.5~29 yr, median: 5.3 yr). Among all patients, 22 (21.6%) underwent operations for recurrence. The re-operation rate was higher in the younger patients group (age at diagnosis less than 25 years) (34.1% vs. 12.1%, P<0.05), and in case of the patients whose length of initial intestinal resection was less than 40 cm (27.9% vs. 7.7%, P<0.05). The overall cumulative re-operation rates at 5years, 10years and 15years were 15%, 25%, and 60%, respectively.
CONCLUSIONS
Despite recent advances in medical therapy, the cumulative re-operation rate of patients operated for gastrointestinal CD remains similar to our previous report in 1997.