Surgical treatment of inflammatory bowel diseases in northwestern Italy: a multicentric study by the G.S.M.I.I. (Inflammatory Bowel Disease Study Group).
OBJECTIVE
Improved medical therapy and bowel sparing and sphincter saving techniques have changed surgery for UC and CD. Collaboration between gastroenterologists and surgeons is necessary to uniform the indications for surgical treatment reducing emergency operations. GISMII multicentric study aimed to show indications, timing and impact of surgery, through retrospective analysis of cases observed between 1992 to 1996.


METHODS
Data were obtained by 16 departments of General Surgery.


RESULTS
102 UC and 376 CD patients were analyzed. In UC patients surgery was performed for failure of medical therapy in 54%, complications in 28.4%, cancer or dysplasia in 10% of cases, 83.3% elective procedures. 30.4% ileo-anal pouch, 30.4% total procto-colectomies with definitive ileostomies, 32.4% total colectomies with ileo-rectal anastomosis, 6.8% segmental resections, were performed. In CD patients surgery was performed in 21% for medical therapy failure, in 79% for complications. 53.4% of patients were submitted to 1 operation, 84% elective procedures. Reoperations were performed in 46.6% of patients, 70.3% elective procedures. In the first operation bowel resection was performed in 79.1%, stricturoplasty in 14.3%; in the subsequent operations bowel resection 62.8%, stricturoplasty 21.7%, increasing number of temporary or definitive ileo-stomies.


CONCLUSIONS
Collaboration between gastroenterologists and surgeons is necessary to obtain optimal results, reducing the incidence of emergency surgery, and complications. The short period observed between diagnosis and operation (21.4 months) is due to the increasing tendency of gastroenterologists to anticipate a surgical procedure when young patients with a chronic disease need a prolonged medical therapy.
Mortara
G
G
UCP Milano San Carlo, Azienda Ospedaliera Ospedale S. Carlo Borromeo, Milano.
Ghirardi
M
M
Prati
M
M
Danelli
P
P
Nascimbeni
R
R
Terraroli
C
C
Carraro
P Setti
PS
Avesani
E Contessini
EC
Cristaldi
M
M
Sostegni
R
R
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D003082:Colectomy / Q000706:statistics & numerical data; D039021:Colonic Pouches / Q000706:statistics & numerical data; D005260:Female; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D007081:Ileostomy / Q000706:statistics & numerical data; D015212:Inflammatory Bowel Diseases / Q000601:surgery*; D007414:Intestinal Neoplasms / Q000601:surgery; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data