Thesurgery is required in more than 80% of patients with Crohn’s disease (CD).
The aim of surgery is to treat complicated lesions. The most important
principle of the surgery is to perform an intestinal resection as limited as
possible. Crohn’s disease is associated with high rates of postoperative
recurrence. At 10 years after surgery, 75% of patients suffer recurrence and
45% of these require re-intervention. The aim of the study was to identify, the
risk factors of postoperative ‘surgical recurrence’ after the first resection
for Crohn’s disease.
This is a
retrospective study, with prospective collection of data, conducted from
January 1998 to September 2010, which included all patients undergoing surgery
for primary CD. All patients born and living in Tunisia in North Africa. The
diagnosis of CD was confirmed in all cases by histological examination of
endoscopic biopsies or specimen after bowel resection. We excluded from this
study, patients initially operated in another center and patients operated on
for isolated anoperineal lesions of CD. The management was multidisciplinary
and standardized for all patients.
All of the
potential risk factors studied were divided in four groups. Factors related to
the patient (cigarette smoking), to the disease (duration of disease,
anatomical site of disease, type of disease: stricturing, penetrating, mixte or
inflammatory disease), to the type of surgery (extend of bowel resection, the
type of anastomosis and the involvement of section margins) and to the
pharmacological treatment after surgery.
A protocol
was established to ensure regular monitoring during the postoperative period.
Patients were followed both by the surgical team than gastroenterology. All
results of clinical, biological and endoscopic have been noted and transcribed
on patient records.
