Traditionally, in Crohn's disease (CD), surgery has played an essential role in the treatment of complications. TNF-α-blockers have significantly improved results of conservative treatment but they do not definitely cure Crohn's disease.
Aim:
Our aim was to examine the prevalence of and indications for surgical procedures in CD in our hospital.
Material and Methods:
A retrospective survey included all CD patients diagnosed in our hospital referral area during a 10-year period in 1996–2005.
Results:
Altogether 114 new patients with CD were diagnosed, 56 (49%) males, 58 (51%) females. The median follow-up time was 5.0 years. In all, 31 (27%) patients underwent some surgical procedure, and of these, 12 (39%) underwent an emergency operation. The most common indication for surgery was bowel obstruction. The most frequent procedures were ileocolic resection in 12 (39%) patients and small bowel resection in 10 (32%).
Conclusions:
Almost one-third of CD patients needed surgical therapy in an early phase of their disease, and more than one-third of these underwent an emergency procedure. Obstructive symptoms were the most common indication for surgery in the early phase of CD.
RutgeersPVSvan AsscheG: Biological therapies for inflammatory bowel diseases. Gastroenterology2009;136:1182–1197.
2.
BernellOLapidusAHellersG: Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn's disease. Br J Surg. 2000;87:1697–1701.
3.
SimillisCYTReeseGEUmegaeS: A meta-analysis comparing incidence of recurrence and indication for reoperation after surgery for perforating versus nonperforating Crohn's disease. Am J Gastroenterol. 2008;103:196–205.
4.
Lennard-JonesJ: Classification of inflammatory bowel disease. Scand J Gastroenterol1989;170:2–6.
5.
ParksAGGPHardcastleJD: A classification of fistula-in-ano. Br J Surg1976;63:1–12.
6.
LindbergELBHolmquistLHildebrandH: Inflammatory bowel disease in children and adolescents in Sweden, 1984–1995. J Pediatr Gastroenterol Nutr2000;30 (259–264).
7.
CosnesJCSBlainABeaugerieL: Long-term evolution of disease behavior of Crohn's disease. Inflamm Bowel Dis2002;8:244–250.
8.
SiassiMWAHohenbergerWKesslerH: Changes in surgical therapy for Crohn's disease over 33 years: A prospective longitudinal study. Int J Colorectal Dis2007;22:319–324.
9.
HeresbachDAJBretagneJFCruchantE: Crohn's disease in the over-60 age group: A population based study. Eur J Gastroenterol Hepatol2004;16:657–664.
10.
WagtmansMJVHLamersCBvan HogezandRA: Crohn's disease in the elderly: A comparison with young adults. J Clin Gastroenterol1998;27:129–133.
11.
SandsBEAJRosenMJAlsahliM: Risk of early surgery for Crohn's disease: Implications for early treatment strategies. Am J Gastroenterol2003;98:2712–2718.
12.
HurstRDMMChungTPRubinM: Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn's disease. Surgery1997;122:667–668.
MaartenseSDMSlorsJFCuestaMA: Laparoscopic-assisted versus open ileocolic resection for Crohn's disease: A randomized trial. Ann Surg2006;243:143–149.
15.
MilsomJWHKBöhmBMarcelloP: Prospective, randomized trial comparing laparoscopic vs. conventional surgery for refratory ileocolic Crohn's disease. Dis Colon Rectum2001;44:1–8.
16.
OdesSVardiHFrigerM: Cost analysis and cost determinants in a European inflammatory bowel disease inception cohort with 10 years of follow-up evaluationGastroenterology2006;131:719–728.
17.
VindiRLJessTKnudsenE: DCCD study group. Increasing incidences of inflammatory bowel disease and decreasing surgery rates in Copenhagen City and County, 2003–2005: A population-based study from the Danish Crohn colitis database. Am J Gastroenterol2006;101:1274–1282.
18.
Maté-JimenezJMSVicentDPajaresJM: Incidence and prevalence of ulcerative colitis and Crohn's disease in urban and rural areas of Spain from 1981 to 1988. J Clin Gastroenterol. 1994:18(1):27–31.
19.
LeeSLHH: Ultrasonography and computed tomography in suspected acute appendicitis. Semin Ultrasound CT MR. 2003;24:69–73.
20.
WhitleySSPMcLeanAPowerN: The appendix on CT. Clin Radiol2009;64:190–199.
21.
SangwanYPSDJMurrayJJRobertsPL: Perianal Crohn's disease. Results of local surgical treatment. Dis Colon Rectum1996;39:529–535.
22.
TarrantKMBMFramptonCMGearryRB: Perianal disease predicts changes in Crohn's disease phenotype — Results of a population-based study of inflammatory bowel disease phenotype. Am J Gastroenterol2008;103:3082–3093.
23.
SolomonM: Fistulae and abscesses in symptomatic perianal Crohn's disease. Int J Colorectal Dis1996;11:222–226.
24.
SandbornWJFVFeaganBGHanauerSB: American Gastroenterological Association Clinical Practice Committee. AGA technical review on perianal Crohn's disease Gastroenterology2003;125:1508–1530.
25.
ScottHJNJ: Evaluation of surgery for perianal Crohn's disease. Dis Colon Rectum1996;39:1039–1043.
26.
HalmeLSA: Factors related to frequency, type, and outcome of anal fistulas in Crohn's disease. Dis Colon Rectum1995;38:55–59.
27.
HommesDWOBvan BodegravenAAvan HogezandRA: Dutch Initiative on Crohn and Colitis (ICC). Guidelines for treatment with infliximab for Crohn's disease. Neth J Med2006;64:219–229.
28.
TalbotCSPJohnstonMJFinanPJ: Infliximab in the surgical management of complex fistulating anal Crohn's disease. Colorectal Dis2005:7(2):164–168.
29.
D'HaensGRVSVan AsscheGNomanM: Therapy of metronidazole with azathioprine to prevent postoperative recurrence of Crohn's disease: A controlled randomized trial. Gastroenterol2008;135:1123–1129.
30.
RegueiroMSWBaidooLKipKE: Infliximab prevents Crohn's disease recurrence after ileal resection. Gastroenterol2009;136:441–450.
