title: Surgery for Crohn colitis over a twenty-eight-year period: fewer stomas and the replacement of total colectomy by segmental resection.
abstract: BACKGROUND
  This study describes how surgery for Crohn colitis developed between 1970 and 1997, towards the end of which period limited resection and medical maintenance treatment was introduced.
  
  
  METHODS
  A cohort of 211 patients with Crohn colitis (115 population-based), of which 84 had a primary colonic resection (42 population-based), was investigated regarding indication for surgery, the time from diagnosis to operation, type of primary colonic resection, risk for permanent stoma and medication over four 7-year periods.
  
  
  RESULTS
  Comparison of the periods 1970-90 and 1991-97 revealed that active disease as an indication for surgery decreased from 64% to 25% (P<0.01) while stricture as an indication increased from 9% to 50% (P < 0.001). Median time from diagnosis to operation increased from 3.5 to 11.5 years (P < 0.01). Proctocolectomy or colectomy fell from 68.8% to 10% of the primary resections, whereas segmental resection increased from 31.2% to 90%. At the end of the first 7-year period, 26% had medical maintenance treatment, steroids or azathioprine taken by 7%. Corresponding figures for the last period were 70% and 49%. Patients diagnosed during the last two time-periods had less risk for surgery (P = 0.017), permanent stoma (P < 0.01) and total colectomy (P < 0.01). Findings were similar in the population-based cohort.
  
  
  CONCLUSIONS
  Current management of Crohn colitis implies a longer period between diagnosis and surgery, a reduced risk for surgery and permanent stoma, and the replacement of total colectomy by segmental resection.
authors.affiliation: Division of Colorectal Surgery, University Hospital, Linköping, Sweden. Peter.Andersson@lio.se
authors.forename: P
authors.initials: P
authors.lastname: Andersson
authors.forename: G
authors.initials: G
authors.lastname: Olaison
authors.forename: G
authors.initials: G
authors.lastname: Bodemar
authors.forename: P O
authors.initials: PO
authors.lastname: Nyström
authors.forename: R
authors.initials: R
authors.lastname: Sjödahl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D015331:Cohort Studies; D003082:Colectomy; D003092:Colitis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D016737:Proctocolectomy, Restorative; D012086:Reoperation; D054047:Surgical Stomas; D013997:Time Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal