Segmental resection or subtotal colectomy in Crohn's colitis?
OBJECTIVE
Segmental resection for Crohn's colitis is controversial. Compared with subtotal colectomy, segmental resection is reported to be associated with a higher rate of re-resection. Few studies address this issue, and postoperative functional outcome has not been reported previously. This study compared segmental resection to subtotal colectomy with anastomosis with regard to re-resection, postoperative symptoms, and anorectal function.


METHODS
Fifty-seven patients operated on between 1970 and 1997 with segmental resection (n = 31) or subtotal colectomy (n = 26) were included. Reoperative procedures were analyzed by a life-table technique. Segmentally resected patients were also compared separately with a subgroup of subtotally colectomized patients (n = 12) with similarly limited colonic involvement. Symptoms were assessed according to Best's modified Crohn's Disease Activity Index and an anorectal function score.


RESULTS
The re-resection rate did not differ between groups in either the entire study population (P = 0.46) or the subgroup of patients with comparable colonic involvement (P = 0.78). Segmentally resected patients had fewer symptoms (P = 0.039), fewer loose stools (P = 0.002), and better anorectal function (P = 0.027). Multivariate analysis revealed the number of colonic segments removed to be the strongest predictive factor for postoperative symptoms and anorectal function (P = 0.026 and P = 0.013, respectively).


CONCLUSIONS
Segmental resection should be considered in limited Crohn's colitis.
Andersson
P
P
Department of Surgery, Division of Colorectal Surgery, University Hospital, Faculty of Health Sciences, University of Linköping, Linköping, Sweden.
Olaison
G
G
Hallböök
O
O
Sjödahl
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D002648:Child; D003082:Colectomy; D003092:Colitis / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D003106:Colon / Q000503:physiopathology / Q000601:surgery; D003424:Crohn Disease / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020127:Recovery of Function / Q000502:physiology; D012007:Rectum / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D016896:Treatment Outcome