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Clinical factors contributing to rapid reoperation for Crohn's disease patients undergoing resection and/or strictureplasty. J Gastrointest Surg 2007 Dec;11(12):1692-8; dicussion 1698

Date

10/18/2007

Pubmed ID

17940830

DOI

10.1007/s11605-007-0298-5

Scopus ID

2-s2.0-36148994753   14 Citations

Abstract

Although surgically induced remission of Crohn's disease following segmental resection/strictureplasty is effective and durable, a subpopulation of patients will require rapid reoperation. We reviewed our inflammatory bowel disease center's database to identify patients who underwent multiple laparotomies. A retrospective analysis of consecutive Crohn's disease patients (1998-2004) was performed, and patients requiring repeat laparotomy were identified. Rapid reoperation was defined as repeat intestinal surgery within 2 years. Demographic data and medical treatment were recorded. Clinical factors contributing to rapid reoperation were defined as (1) symptomatic adhesion, (2) residual strictures/technical error, (3) lack of effective medical therapy, and (4) severe disease despite medical treatment. Of 432 patients, 65 required two or more abdominal explorations, with 32 patients requiring rapid reoperation (50 surgeries). Residual strictures and technical error accounted for 20% of procedures; ineffective medical therapy was identified in 64%, whereas severe disease despite medical therapy was a contributing factor in 14%. Adhesions were found in a single patient. Kaplan-Meier analysis confirmed that rapid reoperation patients had significant and consistently shorter intervals between surgical procedures (i.e., interval between procedures 1 and 2 and 2 and 3). Residual strictures manifest during postop year 1, whereas recurrence of severe disease was the dominant contributing factor during year 2. Our data suggest that operative strategies emphasizing occult stricture detection and adequate medical therapy in Crohn's disease patients may improve outcome and decrease the need for rapid re-exploration.

Author List

Binion DG, Theriot KR, Shidham S, Lundeen S, Hatoum O, Lim HJ, Otterson MF

Authors

Sarah J. Lundeen NP Nurse Practitioner Surgical in the Surgery department at Medical College of Wisconsin
Mary F. Otterson MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Combined Modality Therapy
Constriction, Pathologic
Crohn Disease
Female
Humans
Intestine, Small
Laparotomy
Male
Reoperation
Retrospective Studies
Time Factors
Treatment Outcome
jenkins-FCD Prod-480 9a4deaf152b0b06dd18151814fff2e18f6c05280