[The place of surgery and its influence on recurrence in the evolution of Crohn's disease]. / La place de la chirurgie et son influence sur la récidive dans l'évolution de la maladie de Crohn.

This retrospective study analyses the results of 37 patients suffering from Crohn's disease and submitted to surgery. 49 operations were carried on with a follow up ranging from 24 to 276 months. Lesions were mainly located in the ileo-colic segment (24 cases) the rectum (8 cases), the colon (9 cases) and the anus or rectum (10 cases). The operative mortality was about 8% and long term results show an overall recurrence rate of 66.6%, the average follow up being 88 months. Nutritional complications associated with a constant increase of the recurrence rate should lead to avoid reiterated resections. A conservative therapy under medical surveillance is then indicated and in case of surgical management, parsimonious resections are required but the anastomosis should not involve pathological tissues. The surgical management of Crohn's disease being a temporary and sometimes mangling solution should only be required in case of medical treatment failure or while facing evolution complications.

[Chronic pancreatitis--drainage or resection?]. / Chronische Pankreatitis--Drainage oder Resektion?

In certain cases of chronic pancreatitis, the severity of the disease can lead to surgery. In the indication for operation 4 factors are determining: development of complications, severe intractable pain, cachexia of pancreatic origin, and the diminishing cases of suspicion of carcinoma. The surgical strategy depends mostly on the enlargement of the Wirsungian duct and on the topography of the lesions. Has the Wirsungian duct reacted at least 1 cm in diameter on 6-7 cm length, a latero-lateral isoperistaltic wirsungo-jejunostomie with Roux-en-Y loop seems to be a worthwhile procedure. Are the lesions located predominatly in the head of the pancreas with a narrowed Wirsungian duct, a subtotal duodenopancreatectomy is indicated. If the body and tail of the gland are mostly involved, a left pancreatectomy will be performed, combined with one of the different possibilities of a retrograde drainage of the remaining right pancreas. Follows a critical analysis of the 197 cases operated by the authors. After discussion of mortality and morbidity, late results are studied, patients being divided into 2 groups according to a follow-up of 5 years or less. 56% of the patients treated by subtotal duodenopancreatectomy demonstrated good results after 5 years. But only 43 % of patients with a wirsungo-jejunostomy and 38% of patients with left pancreatectomy belonged to this group. Finally, arguments in favour of a drainage procedure or resection are specified.