title: Comparison of the results of resection, bypass, and bypass with exclusion for ileocecal Crohn's disease.
abstract: Controversy continues regarding the optimal surgical treatment of Crohn's disease involving the ileum and cecum. Over 43-years, 161 patients underwent primary surgery for this disease at The New York Hospital-Cornell Medical Center. Resection was performed in 115 patients, bypass with exclusion in 25, and side-to-side ileotranverse colostomy in 21. Overall recurrence rates were 25% for resection, 63% for bypass with exclusion, and 75% for simple bypass. Expressed as 15 year follow-up, recurrence rate were 65% for resection, 82% for bypass with exclusion, and 94% for simple bypass. Much of the difference in final outcome was accounted for by early recurrence or by persistent disease in the two bypass groups. This amounted to 21% for the bypass with exclusion and 45% for simple bypass as compared to 3% for patients who had resection. Conclusions from this review are that 1) resection can be performed with a morbidity and mortality equivalent to either of the bypass procedures; 2) the recurrence rat following resection is significantly lower than bypass with exclusion or simple bypass, and amounts to about 4% per year; 3) continuing disease in the bypassed loop accounts for a high percentage of reoperations in the bypass groups, while appearance of new disease is the usual problem following resection; 4) resection is the surgical treatment of choice for ileocecal Crohn's disease.
mesh_terms: D000328:Adult; D003125:Colostomy / Q000379:methods*; D003424:Crohn Disease / Q000401:mortality / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications; D012008:Recurrence