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Background. Relationship between surgery, quality of life (QoL) and nutrition in Crohn's Disease (CD) patients is unclear. Aim of the study was to evaluate the consequences of surgical resection on the QoL with particular regard to nutritional aspects, of a consecutive group of CD patients under regular follow up.
Methods. Eighty consecutive patients undergoing ileocecal resection were randomly selected from database. Patients were divided into 2 groups: A laparoscopic and B open resection. Body Mass Index (BMI), biochemical levels of albumin, creatinine, urea, cholesterol, triglycerides, serum iron, ferritin and complete blood count (Hb hemoglobin and Ht hematocrit) were recorded before surgery and 6 and 12 months after the operation. The Student t test was performed in order to find differences before and after surgery. Patients were also asked to fill out the specific IBDQ-QoL questionnaire and a second multiple choice questionnaire designed to specifically evaluate nutritional aspects.
Results. Data from 68 patients (31group A and 37 group B) were completed in order to make comparisons. The two groups were homogeneous in term of gender, age and duration of disease. BMI significantly increase after surgery in the short and long term in group A (p 0.002 and 0.0001) and at 12 moths in group B (p 0.003). Albumin levels also showed a significant increase in both groups 6 months after surgery (A:p=0.0001 and B:p=0.015), whilst a further increase at 12 months is seen only in group A (p=0.04). Serum iron level is increased 12 months after I-C resection (group A p=0.003; group B p=0.02), and so is the Hb level (group A p=0.02; group B p=0.05). Significant differences in Ht were visible at 12 month only in group A (p=0.02).
Thirty-five patients (68.5%) filled the IBDQ-QoL questionnaire. Mean score was 163/224 with no differences between the two groups. All patients filled the nutritional based questionnaire: 52% before surgery but only 9.5% after after ileo-cecal resection were forced on a specific diet. 71.5% of patients believe its QoL improved after ileo-cecal resection, whilst 20 % sees no differences and 8.5% a worsening. No significant differences were noted between groups.
Conclusion. QoL, with particular regard to nutritional aspects seems ameliorate after ileo-cecal resection in CD patients. Laparoscopic surgery may play a role in the middle and long term outcome probably thanks to the shortest recovery time and the favorable acceptation among patients .