title: The Clinical Features and Predictive Risk Factors for Reoperation in Patients With Perianal Crohn Diseases; A Multi-Center Study of a Korean Inflammatory Bowel Disease Study Group.
abstract: OBJECTIVE
  Perianal lesions are common in Crohn disease, but their clinical course is unpredictable. Nevertheless, predicting the clinical course after surgery for perianal Crohn disease (PCD) is important because repeated operations may decrease patient's quality of life. The aim of this study was to predict the risk of reoperation in patients with PCD.
  
  
  METHODS
  From September 1994 to February 2010, 377 patients with PCD were recruited in twelve major tertiary university-affiliated hospitals and two specialized colorectal hospitals in Korea. Data on the patient's demographics, clinical features, and surgical outcomes were analyzed.
  
  
  RESULTS
  Among 377 patients, 227 patients were ultimately included in the study. Among the 227 patients, 64 patients underwent at least one reoperation. The median period of reoperation following the first perianal surgery was 94 months. Overall 3-year, 5-year, and 10-year cumulative rates of reoperation-free individuals were 68.8%, 61.2%, and 50.5%, respectively. In multivariate analysis (Cox-regression hazard model), reoperation was significantly correlated with an age of onset less than 20 years (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.07-3.48; P = 0.03), history of abdominal surgery (HR, 1.99; 95% CI, 1.08-3.64; P = 0.03), and the type of surgery. Among types of surgery, fistulotomy or fistulectomy was associated with a decreased incidence of reoperation in comparison with incision and drainage (HR, 0.19; 95% CI, 0.09-0.42; P < 0.001).
  
  
  CONCLUSIONS
  Young age of onset and a history of abdominal surgery were associated with a high risk of reoperation for PCD, and the risk of reoperation were relatively low in fistulotomy or fistulectomy procedures.
authors.affiliation: Department of Surgery, Daehang Hospital, Seoul, Korea.
authors.forename: Jae Bum
authors.initials: JB
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul Song Do Hospital, Seoul, Korea.
authors.forename: Seo-Gue
authors.initials: SG
authors.lastname: Yoon
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyu Joo
authors.initials: KJ
authors.lastname: Park
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kang Young
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Catholic University of Daegu School of Medicine, Daegu, Korea.
authors.forename: Dae Dong
authors.initials: DD
authors.lastname: Kim
authors.affiliation: Department of Surgery, Hallym University Kangnam Sacred Heart Hopital, Hallym University College of Medicine, Seoul, Korea.
authors.forename: Sang Nam
authors.initials: SN
authors.lastname: Yoon
authors.affiliation: Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chang Sik
authors.initials: CS
authors.lastname: Yu
keywords: Perianal Crohn disease; Recurrence; Surgery