Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome

• Published in: International journal of colorectal disease 2008-12, Vol.23 (12), p.1167-1174
• Main Authors: Iesalnieks, Igors, Kilger, Alexandra, Glaß, Heidi, Müller-Wille, Rene, Klebl, Frank, Ott, Claudia, Strauch, Ulrike, Piso, Pompiliu, Schlitt, Hans J., Agha, Ayman
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Biological and medical sciences; Crohn Disease - mortality; Crohn Disease - surgery; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; Hepatology; Humans; Internal Medicine; Intestines - surgery; Male; Medical sciences; Medicine; Medicine & Public Health; Original Article; Other diseases. Semiology; Proctology; Reoperation; Sepsis - etiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Surgery; Survival Rate; Treatment Outcome
• ISSN: 0179-1958; 1432-1262
• DOI: 10.1007/s00384-008-0534-9

Background A number of studies deal with factors affecting postoperative recurrence; however, they do not analyze the influence of postoperative morbidity on the long-term outcome. This was the aim of the present study. Materials and methods Two hundred eighty-two patients underwent 331 intestinal resections for primary or recurrent Crohn’s disease between 1992 and 2005. Closure of ileostomy or colostomy, isolated stricturoplasty, abdominoperineal resection for perianal disease, and reoperations for postoperative complications were excluded. “Surgical recurrence” was defined as a development of stricturing or perforating disease necessitating repeat surgical therapy. Results Anastomotic leak, intraabdominal abscess, enterocutaneous fistula (intraabdominal septic complications, IASC) occurred after 46 operations (16%). Four patients died (1.2%). By multivariate analysis, articular disease manifestation ( p = 0.03), duration of symptoms leading to surgery ( p = 0.009), and weight loss ( p = 0.03) were associated with occurrence of postoperative complications. Surgical recurrence occurred following 86 bowel resections, and 36 occurred during the first postoperative year. The following factors were associated with an increased risk of surgical recurrence by multivariate analysis: postoperative IASC ( p = 0.0002) and previous bowel resections ( p = 0.002). Patients suffering IASC had statistically significantly higher 1-, 2-, 5-, and 10-year surgical recurrence rate (25%, 29%, 50%, and 57%) than patients without IASC (4%, 7%, 19%, and 38%, p = 0.0003). Conclusion The incidence of the postoperative IASC is predominantly determined by preoperative disease severity. IASC have a detrimental influence on the long-term outcome following intestinal resections in patients with Crohn’s disease, leading to increased number of repeat resection surgery.