title: Surgical treatment of Crohn's disease: indications, results and predictive factors of recurrence and morbidity.
abstract: BACKGROUND
  Crohn's disease management represents a major problem in gastroenterology and general surgery because it affects young subjects and has a major impact on their quality of life. The aims of our study were to identify the indications for surgery in Crohn's disease, the results and the complications of surgery in our series, and to identify possible predictive factors of recurrence and postoperative morbidity.
  
  
  METHODS
  A retrospective descriptive study including 38 cases of patients with Crohn's disease who underwent surgical treatment in the department of surgery in Mongi Slim Hospital, during the period between January 1992 and December 2011 was performed.
  
  
  RESULTS
  The occurrence of stenosis was the most common indication for surgical treatment in Crohn's disease in our series, and ileocecal resection was the most performed surgery. Twenty six patients (58%) received maintenance therapy after surgery. Twenty two patients relapsed and 13 had surgical management for recurrence. In univariate analysis, predictive factors of post operative morbidity in our study were leukocytosis, penetrating phenotype and intraabdominal sepsis. Ileocecal location was the only factor that significantly improved the incidence of recurrence. In multivariate analysis, only penetrating phenotype was a predictive factor or post operative morbidity.
  
  
  CONCLUSIONS
  Despite the development of medical treatment, surgical treatment keeps large indications for the management of complications of Crohn's disease. The surgery should be an alternative to immunosuppressive therapy. Currently, prevention postoperative recurrence is well codified, reducing the risk of complications.
authors.forename: Rania
authors.initials: R
authors.lastname: Hefaiedh
authors.forename: Mariem
authors.initials: M
authors.lastname: Sabbeh
authors.forename: Nizar
authors.initials: N
authors.lastname: Miloudi
authors.forename: Rym
authors.initials: R
authors.lastname: Ennaifer
authors.forename: Hayfa
authors.initials: H
authors.lastname: Romdhane
authors.forename: Najet
authors.initials: N
authors.lastname: Belhadj
authors.forename: Lassad
authors.initials: L
authors.lastname: Gharbi
authors.forename: Tahar
authors.initials: T
authors.lastname: Khalfallah
mesh_terms: D000293:Adolescent; D000328:Adult; D002432:Cecum / Q000601:surgery; D003082:Colectomy; D003251:Constriction, Pathologic; D003424:Crohn Disease / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014416:Tunisia / Q000453:epidemiology