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2007 Program and Abstracts | 2007 Posters
Surgical Management and Outcome of Patients with Duodenal Crohn's Disease
Mark Shapiro*, Alexander Greenstein, John Byrn, Jacqueline Corona, Barry Salky, Adrian J. Greenstein, Celia M. Divino
Department of Surgery, The Mount Sinai Hospital, New York, NY

Introduction. Duodenal Crohn's disease is a rare illness that was first described in 1937 and has been reported to occur in 0.5-4% of patients with Crohn's disease. Medical therapy is the first line of treatment, but when patients fail to respond to conservative therapy or develop severe narrowing of the duodenum, surgery is required. The recent literature is limited in description of surgical treatment of such patients. We reviewed our experience with surgical management and outcome in patients with duodenal Crohn's disease.Methods. A retrospective review was undertaken of 29 patients who underwent surgical intervention for duodenal Crohn's disease between 1995 and 2006.Results. Since 1995, 29 patients received a total of 33 operations for treatment of duodenal Crohn's disease. Average age of the patients was 40 years, and all presented for surgery with obstructive symptoms. Concurrent disease in other parts of the gastrointestinal system was present in 24 patients (83%). Fourteen patients underwent open bypass procedure, ten underwent laparoscopic bypass surgery, four were treated for duodenal fistula, and one had laparoscopic strictureplasty done. Patients were followed for an average period of 46 months (range 6-99). The overall complication rate was 17% within 30 post-op days, with the same long-term recurrence rate. In the group of 14 patients who had open bypass done, there were four complications (29%), two of which required re-operation, and two recurrences. In the group of ten patients treated laparoscopically, there was one complication (10%) and three recurrences. In each group, one patient ultimately required a revision for their recurrence.Conclusion. Surgery is a viable and safe option for patients with intractable duodenal Crohn's disease. The recurrence rate (17%) after surgery falls within historical rates (17-55% within 5 years) for patients undergoing surgical treatment for Crohn's disease of other intestinal regions. The attractiveness of a surgical solution has been enhanced by increased utilization of the laparoscopic bypass, a procedure that is accompanied by less morbidity and a comparable recurrence rate when compared to traditional open bypass.


2007 Program and Abstracts | 2007 Posters
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