[Postoperative morbidity after bowel resections in patients with Crohn's disease: risk, management strategies, prevention].
The postoperative morbidity rate following bowel resections for Crohn's disease is higher than for other benign disease. The incidence of postoperative intraabdominal septic complications (anastomotic leak, bowel fistula, intraabdominal abscess, peritonitis) is 5 - 30 %. Preoperative weight loss, prolonged refractory symptoms and penetrating disease behaviour are significant determinants of postoperative complication risk. Preoperative enteral nutrition, antibiotics, percutaneous abscess drainage and cessation of steroids might reduce the risk of surgery, however, more evidence is needed. The intake of immunosuppressive agents (mainly, azathioprine) can be continued perioperatively. The occurrence of postoperative intraabdominal septic complications is associated with an increased risk of surgical recurrence in patients with terminal ileitis, however, the long-term prognosis could be improved in the latter patients by secondary fecal diversion. There is no association between postoperative morbidity and long-term outcome in patients with Crohn's colitis.
Abteilung für Allgemein- und Viszeralchirurgie, Marienhospital Gelsenkirchen. i.iesalnieks@marienhospital.eu
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Iesalnieks
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Dederichs
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Kilger
H J
HJ
Schlitt
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Agha
D015897:Comorbidity; D003424:Crohn Disease / Q000453:epidemiology* / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D006801:Humans; D007422:Intestines / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D018805:Sepsis / Q000453:epidemiology*; D016896:Treatment Outcome