title: Surgery for intestinal Crohn's disease recurrence.
abstract: BACKGROUND
  Operative therapy for Crohn's disease (CD) recurrence is supposed to be more complex and demanding than primary resection. The purpose of this study was to assess a postoperative course after reoperation for the recurrence of CD.
  
  
  METHODS
  From 1998 to 2008, 61 patients underwent reoperation for the recurrence of CD. First, risk factors for postoperative morbidity, with special reference to major postoperative complications, were analyzed. Second, a case-matched study was used to compare the postoperative morbidity of 54 ileocolonic resections for the recurrence of CD (reoperation group) with 57 identical primary ileocolonic resections (primary resection group) according to matching criteria (age, fistulizing or stenotic disease, pre-operative steroids therapy, pre-operative general status, and surgical approach).
  
  
  RESULTS
  Postoperative mortality was nil. Postoperative complications were observed in 23 cases (38%). Of these cases, 6 (10%) had major complications (2 anastomotic leakages and 6 intra-abdominal abscesses requiring radiological drainage). Univariate analysis did not identify risk for major complication. None of the 14 patients with temporary stoma developed a major complication (NS). A case-matched study showed a higher morbidity rate (21/54 vs 5/57; P = .0006) with a greater risk of postoperative intra-abdominal abscess (9/59 vs 1/59; P = .007) and a longer postoperative hospital stay in reoperation versus the primary resection group (9 vs 7 days; P < .001).
  
  
  CONCLUSIONS
  Reoperation for CD recurrence is demanding and complex with a frequent need for an associated surgical procedure (because of the severity of the disease and/or adherences). It also is associated with a higher morbidity rate and a longer hospital stay than primary resection. For these reasons, the indication of temporary defunctionning stoma should be discussed systematically in these patients.
authors.affiliation: Department of Colorectal Surgery, Beaujon Hospital, University Paris VII, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Brouquet
authors.forename: Benjamin
authors.initials: B
authors.lastname: Blanc
authors.forename: Frederic
authors.initials: F
authors.lastname: Bretagnol
authors.forename: Patrice
authors.initials: P
authors.lastname: Valleur
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.forename: Yves
authors.initials: Y
authors.lastname: Panis
mesh_terms: D000328:Adult; D000368:Aged; D002432:Cecum / Q000601:surgery; D003424:Crohn Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors