Comparison of primary and reoperative surgery in patients with Crohns disease

• Published in: Annals of surgery 1998-04, Vol.227 (4), p.492-495
• Main Authors: HEIMANN, T. M, GREENSTEIN, A. J, LEWIS, B, KAUFMAN, D, HEIMANN, D. M, AUFSES, A. H
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Colostomy; Crohn Disease - surgery; Female; Humans; Ileostomy; Male; Medical sciences; Proportional Hazards Models; Prospective Studies; Recurrence; Reoperation; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-199804000-00007

This study was performed to determine the clinical results of patients with Crohns disease who require surgical resection. The outcome of patients undergoing initial surgery was compared with those having reoperation. One hundred sixty-four patients undergoing intestinal resection for Crohns disease at The Mount Sinai Hospital from 1976 to 1989 were studied prospectively. The mean duration of follow-up was 72 months. Ninety patients (55%) underwent initial intestinal resection whereas 74 patients (45%) underwent reoperation for recurrent disease. Patients undergoing reoperation were older (33.4 vs. 38.7 years), had longer durations of disease (8.7 vs. 15.2 years), had shorter resections (60 vs. 46 cm), and were more likely to require ileostomy. Forty-seven percent of the patients with multiple previous resections required an ileostomy. This group also received a mean of 2.3 U blood in the perioperative period and showed a trend to increased symptomatic recurrence (49% vs. 71% at 5 years). Patients with Crohns disease undergoing first and second reoperation have outcomes similar to those in patients undergoing primary resection. Patients requiring multiple reoperations are more likely to require blood transfusions and permanent ileostomy and to show a greater trend to early symptomatic recurrence.