Postoperative Complications and Recurrence in Patients with Crohn's Disease

ABSTRACT

PURPOSE: This study was performed to assess postoperative complications and recurrence rates and to elucidate the risk factors in Crohn's disease (CD). METHODS: A retrospective review was undertaken for patients who had undergone bowel surgery at Asan Medical Center between October 1991 and June 2006. Symptomatic recurrence was defined as the presence of symptoms related to CD that was subsequently verified by radiologic or endoscopic finding. Surgical recurrence was defined as the need for repeated surgery for enteric CD. RESULTS: There were 160 patients with a mean follow up of 34 months (108 men and 52 women; mean age 29.7+/-10.9). The most common indication for surgery was a complication of CD, such as intra-abdominal abscess (31.9%), intestinal obstruction (21.9%), and internal fistula (19.4%). Another frequent indication was medical intractability (23.8%). The types of surgical procedures were ileocolic resection (50.0%), small bowel resection (25.0%), total/subtotal colectomy (17.5%), and others. The cumulative symptomatic recurrences were 15.9% and 36.4% at 2 and 5 years, and the cumulative surgical recurrence was 13.6% at 5 years. The cumulative surgical recurrence was higher for stricturing-type CD than for penetrating-type CD (P=0.049). No other significant risk factor for recurrence was found in our study. Twenty patients (12.5%) had postoperative complications, such as intra-abdominal abscess, anastomosis leakage, obstruction, and wound infection. CONCLUSIONS: The postoperative complication and recurrence rates were acceptable. For stricturing-type Crohn's disease surgical recurrence is higher than penetrating type, but long-term follow up is needed to verify the risk factors for recurrence.