title: Recurrence and impact of postoperative prophylaxis in laparoscopically treated primary ileocolic Crohn disease.
abstract: OBJECTIVE
  To define risk factors for recurrence and to determine whether postoperative prophylaxis would influence time to recurrence after primary laparoscopic ileocolectomy for Crohn disease.
  
  
  METHODS
  Retrospective record review.
  
  
  METHODS
  Tertiary academic medical center.
  
  
  METHODS
  All patients who underwent primary laparoscopic ileocolectomy for terminal ileal Crohn disease between April 28, 1994, and August 3, 2006, at the Mayo Clinic, Rochester, Minnesota.
  
  
  METHODS
  All patients were reviewed for follow-up, recurrence, risk factors for recurrence, and use of postoperative immunosuppressive prophylaxis.
  
  
  RESULTS
  One hundred nine patients were identified, of whom 89 were followed up postoperatively at Mayo Clinic with a median follow-up of 3.5 years (range, 1.8 months to 11.9 years). Recurrence was discovered in 54 patients (61%) at a median of 13.1 months (range, 1.3 months to 8.7 years). Forty-four patients (49%) received postoperative immunosuppressive prophylaxis (37 [42%] received azathioprine, 8 [9%] received 6-mercaptopurine, and 3 [3%] received infliximab). In a multivariate model of various risk factors for recurrence, presence of granulomas was the only significant predictor of recurrence (P = .01). The 2-year cumulative recurrence rates in the prophylaxis and nonprophylaxis groups were 37.5% and 52.6%, respectively (log-rank test, P = .87).
  
  
  CONCLUSIONS
  Recurrence occurred in more than half of the patients with Crohn disease after primary laparoscopic ileocolectomy. In this highly selected patient population, use of immunosuppressive prophylaxis was not associated with a delay in recurrence. Presence of granulomas was the only significant predictor of recurrence. These findings should be further explored in larger and less selected patient populations.
authors.affiliation: Division of Colorectal Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Kishore
authors.initials: K
authors.lastname: Malireddy
authors.forename: David W
authors.initials: DW
authors.lastname: Larson
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: William A
authors.initials: WA
authors.lastname: Faubion
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.forename: Rui
authors.initials: R
authors.lastname: Qin
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Gullerud
authors.forename: Robert R
authors.initials: RR
authors.lastname: Cima
authors.forename: Bruce
authors.initials: B
authors.lastname: Wolff
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Dozois
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007079:Ileitis / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery*; D007155:Immunologic Factors / Q000008:administration & dosage; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D055815:Young Adult
chemical_list: D007155:Immunologic Factors