Results of operative management of Crohn's disease

Abstract

A computer analysis was made of clinical experience of Crohn''s disease in Australian patients. Between 1950-1978, 50 patients were managed for Crohn''s disease. This group represented 3.1% of 1608 patients treated during the same period for primary inflammatory bowel disease. The mean follow-up period was 8.4 yr. Thirty-nine of the 50 patients were female and 11 male. The small intestine was involved in 7 patients, large intestine in 17 and small and large intestine in 26. Symptoms were related to the anatomic localization of disease. Four patients have died (2 postoperative deaths and 2 unrelated to Crohn''s disease). Forty-nine of the 50 patients required operative procedures and 36 underwent 1 or more definitive operations with curative intention. A total of 124 operations was performed, 70 of which were definitive. Twenty-nine of the 36 patients managed by a definitive operation developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed 2 or more recurrences. Multiple recurrences were most frequent after operation for combined small and large intestinal Crohn''s disease. No patient with large intestinal Crohn''s disease alone developed more than 1 recurrence. Each patient undergoing subtotal colectomy with ileorectal anastomosis (6 patients) or ileostomy (9 patients) required 1 or more further definitive operations. Recurrence was more frequent after the 1st than 2nd definitive operation (P = 0.007), the median recurrence-free intervals being 11 and 23 mo., respectively.