Early re-laparotomy for post-operative complications is a significant risk factor for recurrence after ileocaecal resection for Crohn's disease.
BACKGROUND
There is evidence suggesting that stenosing and fistulising Crohn's diseases reflect specific entities. The aim of this study was to compare these two clinical presentations with regards to anastomotic recurrence after ileocaecal resection and identify other relevant risk factors.


METHODS
One hundred consecutive patients undergoing isolated ileocaecal resection for Crohn's disease were included in this follow-up study. A recurrence was either defined endoscopically, on the basis of radiological examinations or on the basis of a re-operation. In addition, patients had to complain of clinical symptoms. Recurrence-free intervals were calculated by the Kaplan-Meier method. Univariate and multivariate analysis including previously identified risk factors for recurrence were performed.


RESULTS
Of the 100 patients extracted from the database, 8 patients were lost to follow-up or refused participation. There was no mortality in this patient group, the morbidity was 16.3%. The recurrence rates after 5 and 9 years were 28.7% and 56.4%, respectively. Univariate analysis revealed re-laparotomy within the same hospital stay and length of resected specimen as significant factors for anastomotic recurrence. Both these factors were confirmed on multivariate analysis. But when analysing the observation period in detail, specimen length was not any more a significant factor in the later time period (1996-2000) compared to the earlier time period (1991-1995). The clinical presentation (fistulising vs stenosing) showed no significant influence on the recurrence rates.


CONCLUSIONS
Patients with stenosing and fistulising Crohn's disease of the ileocaecal region have no difference in recurrence rates after resection. Re-laparotomy in the same hospital stay was an independent predictor of recurrence.
Welsch
Thilo
T
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
Hinz
Ulf
U
Löffler
Thorsten
T
Muth
Gregor
G
Herfarth
Christian
C
Schmidt
Jan
J
Kienle
Peter
P
D000328:Adult; D003424:Crohn Disease / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery*; D007412:Intestinal Fistula / Q000150:complications; D007422:Intestines / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors