Clinical and surgical recurrence of Crohn's disease after ileocolonic resection in a specialist unit.
BACKGROUND
Postoperative clinical and endoscopic recurrence is common in Crohn's disease.


OBJECTIVE
We aimed to assess postoperative recurrence and management in a cross-sectional patient cohort in one specialist unit, before the introduction of a uniform postoperative preventive strategy.


METHODS
Review of patients who had an ileocolonic resection for Crohn's disease between 2002 and 2005 in a secondary and tertiary care specialist centre.


RESULTS
Ninety-nine patients (42 male; 57 female; mean age, 37 years) with a median disease duration of 10 years, were reviewed. Indications for surgery were obstruction (n=61), failed medical therapy (n=31) and internal fistula(e) (n=7). Thirty patients (30%) were active smokers at the time of resection. Fifty patients (51%) had at least one previous Crohn's resection. Clinical and surgical recurrence rates were 28 and 5%, respectively, at 1 year. All five patients had the same indication for their further surgery as for their index operation (four fistulizing or stricturing). Median time to clinical recurrence was 10 months in those with recurrence. Nineteen percent of patients had an ileocolonoscopy at a median of 6 months after surgery, and 60% had been reviewed by a gastroenterologist, after surgery. Clinical recurrence occurred in nine of 28 (32%) without and 19 of 71 with (26%) postoperative medical therapy (P=NS).


CONCLUSIONS
Postoperative recurrence of Crohn's disease was high in the short term. The indication for repeat surgery stayed true within patients. Prospective treatment strategies, based on recent trial evidence, are needed to diminish postoperative recurrence.
Ng
Siew C
SC
Department of Gastroenterology, St Mark's Hospital, London, UK.
Lied
Gulen Arslan
GA
Arebi
Naila
N
Phillips
Robin K
RK
Kamm
Michael A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D003106:Colon / Q000601:surgery*; D003424:Crohn Disease / Q000601:surgery*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007415:Intestinal Obstruction / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult