Surgical treatment for relapsing Crohn's disease

According to the National American Crohn's Study about 80–90% of patients with Crohn's disease are likely to be operated on during a 20 year disease period. Since Crohn's disease has ability to relapse therefore it needs several times further surgical interventions.

The aim of the present study was to analyze our surgical treatment for recidivist Crohn's disease and to compare it to international literature data.

Patients and methods: Between 1993 and 2004 88 patients underwent surgery for Crohn's disease. 54 patients had no previous surgical interventions. However 34 patients underwent repeated surgical treatment once (n=15) or more times (n=19) due to the recurrance of inflammatory bowel disease.

Results: In the group of patients (34 patients) who underwent repeated operations we have performed in 9 cases ileocoecal resection or right hemicolectomy, in 2 cases total colectomy, in 15 cases segmental resection, in 3 cases stricturoplasty. In 5 cases we performed the operation because of interintestinal fistles or abdominal abscess. In 5 cases we operated on the upper gastrointestinal tract. In 6 cases resection of the anastomosis was done due to relapse of inflammatory bowel disease in the anastomosis. Deviating stoma was done in 14 cases. In 7 cases we did perianal fistulectomy. In 4 cases postoperative complications occured (2 anastomosis insufficiency, 2 abdominal abscess). The mortality was zero.

Conclusion: Up to date, there have been no surgical maneuvers which have been proved to decrease the risk of recurrence of Crohn's disease. Therefore we would like to emphasize the application of organ preserving procedures i.e. sparing resections, causing minimal trauma and using suitable methods both for the patient and the case.