Reintervention Rate Following Emergency Surgery for Crohn Disease

Abstract

Backround/Objective: To assess the impact of emergency surgery and postoperative recurrence in Crohn's disease (CD) and to evaluate the disease course while observing different factors that may influence it. Information on 37 consecutive patients which were diagnosed and operated in emergency for CD complications and the the relapse rate (regarded as a second surgery) were retrospectively evaluated. The risk of relapse and second surgery was increased in males under 50 years and in those who benefited from an anastomosis during the first invervention while stomy seemed to reduce the rate of surgical relapse. The median duration until relapse was 2,3 years while a percentage of 33% required reintervention. The majority of patients with CD will undergo at least one surgical intervention during their lifetime and one third of them will relapse requiring a second intervention. Although medical treatment has seen great advancements, surgery requirements have remained unchanged as the mainstay treatment in emergent complications of CD. The age of the patients, smoking status and the postoperative medication influence the rate of postoperative recurrence.

Aspects Towards the Anastomotic Healing in Crohn’s Disease: Clinical Approach and Current Gaps in Research

“…Considering that most CD patients will require surgical treatment over time (2)(3)(4), it becomes a persistent and recurrent dilemma in the daily practice of the surgeon: the decision between indicating an early surgery (incurring all the risks related to the surgical intervention) or continuing to try clinical treatments (at the risk of having to approach the patient later with an even more deteriorated clinical condition).…”

“…Nevertheless a considerable percentage of patients need to undergo surgical treatment one or more times during their lifetime. From 50 to 90% of Crohn's disease (CD) patients, will require some type of surgical procedure along with medical follow-up and treatment period (2)(3)(4). The need to perform a surgical procedure is about 4 times lower (approximately 18%) among patients diagnosed with ulcerative colitis (UC) (2).…”

“…Anastomosis and reoperation are intrinsically related. The realization of an anastomosis increases the risk for urgent reintervention due to AL and in long term, postoperative recurrence typically occurs at the anastomotic site (3).…”