The early and late results of surgical treatment for Crohn's disease

Abstract

SUMMARYAn analysis is presented of the early results of 415 operations performed for Crohn's disease on 295 patients at the Leeds General Infirmary from 1939 to 1968 inclusive. Two hundred and forty-four of the operations were primary and the other 171 were reoperations.The operative mortality was 4.1 per cent after primary operation, 8.2 per cent after reoperation, and 5.8 per cent overall. The most important factor influencing the immediate mortality after primary surgery was the age of the patient, the mortality in patients under 50 years being 2-6 per cent and that in patients over that age 8.9 per cent.The main postoperative complications were sepsis, fluid and electrolyte imbalance, and delay in the healing of the perineal wound, which persisted unhealed for over 6 months in 42 per cent of the patients who had had rectal excision.In the interests of simplicity assessineizt of the ultimate outcome of surgery is confined to an examination of the late results in the 234 immediate survivors of primary operations by means of a followup ranging from 6 months to 30 years. Four patients could not be traced and 2 had had their operations less than 6 months before the completion of the review in 1968, which left 228 patients for analysis. The overall late mortality in this group was 13 per cent. Much of it was due to intercurrent conditions such as would be expected in a matched sample of the general population, but 7 per cent was related to Crohn's disease, being due mostly to septic complications following reoperations.Thirty-four per cent of the patients needed at least one further operation after their initial one for Crohn's disease. However, after reoperation the chances of a third or fourth operation being necessary were not increased. The reoperation rate varied considerably after different primary operations, being lowest after 56 proctocolectomy and highest after by-pass operations and colectomy and ileorectal anastomosis.Symptomatically most of the patients have done well. At the time of review 87 per cent of them were enjoying good or very good general health (76 per cent of patients after small-bowel operations, but 96 per cent of those after large-bowel operations), and over the period of follow-up 72 per cent of the 'patient-years' were spent free of symptoms.

Predictive value and clinical significance of myenteric plexitis in Crohnʼs disease

“…One consistent predictor of disease recurrence is the behavior of CD. 27,28 We found that disease behavior had no impact on the histological changes of the myenteric plexus, a finding consistent with those of Ferrante et al 25 Other clinical features such as age at surgery and smoking status also had no relationship with the presence of myenteric plexitis.…”

Early Perioperative Results and Surgical Recurrence after Strictureplasty and Miniresection for Complicated Crohn’s Disease

“…The perioperative mortality reported after resection varies from 0.3 to 3.2% [24, 25], but it is 0% after SP [19, 26, 27, 28], and the postoperative septic complication rates are 3–49 [24, 29]and 5–14% [27, 28, 29, 30]. Although we applied conservative techniques more extensively than in other series, our complication rate of 5.8% compares favorably with those reported in the literature [21, 31].…”

Quality of Life in Patients with Inflammatory Bowel Disease

“…The comparative quality of life in patients treated medically and surgically may offer important informa tion for decision making. There are some hints in the literature that surgical treatment results in a better quality of life than medical therapy [14,15],…”

“…Infor mation on quality of life is global and mea surement technics were not or only slightly standardized, de Dombal et al [14] reported that only 20% of the patients treated with drugs in contrast to 70% of the patients who had undergone surgery were without com plaints at follow-up. A comparison of ileos tomy patients suffering from ulcerative coli tis and Crohn's disease by means of a modi fied Visick Index showed that 95% of the colitis patients had good or excellent results.…”