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the Role of Surgery in Crohn's Disease: Single Center Experience From 2005-2014
Florian Kuehn*, Maximilian Nixdorf, Ernst Klar
Dept. of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany
Background: Nowadays, surgery in Crohn's disease is restricted to the treatment of complications. Biologicals have improved results of conservative treatment and have significantly extended the time interval until the first surgical intervention becomes necessary. However, surgery is still required in 70-90% of patients with Crohn's disease.
Objectives: Here, we aimed to examine indication and outcome of patients who underwent surgery in our department. Detailed patients characteristics and predictors for perioperative complications should be evaluated.
Methods: A retrospective analysis included all patients with Crohn's disease (n=120) and need for surgical intervention between 2005 and 2014.
Results: Altogether, 213 operations were performed in 120 patients with Crohn's disease, 65 (54%) males, 55 (46%) females. Median age at first operation was 39 years and 34 years for perianal disease, respectively. Mean duration of disease until the first operation was 6.5 years (range, 0-29). Bowel resections had to be conducted in 94 patients and in nine patients first diagnosis of Crohn's disease was based upon postoperative histology. More than 60% of patients had to undergo more than one operation during their disease time. The most common indication for surgery was bowel obstruction / stenosis (42.5%). The most frequent procedures were ileocolic resection in in 39% of patients. 26 (15%) abdominal operations had to be accomplished as emergency operations from which 13 were caused by bowel perforation. 19 of 53 (36%) stomas were created because of perianal disease. Only 5 of 19 enterostomies for perianal disease could be closed during follow-up. The mean time to closure of enterostomy was 359 days (range, 89-901). Perioperative complications with need for operative revision occurred in 11 (9%) patients. Ten of these patients were on steroid medication > 5mg per day. A Crohn's related carcinoma was detected in 6 patients (5%).
Conclusion: This retrospective analysis showed that perianal disease is associated with early need for surgery. If a deviation becomes necessary for perianal Crohn's disease the rate of enterostomy closure was low. Additionally, a detailed clinical and molecularbiological analysis of patients with Crohn's related carcinoma is necessary in order to detect a possible predisposition in time.
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