Clinical Factors Contributing to Rapid Reoperation for Crohn’s Disease Patients Undergoing Resection and/or Strictureplasty

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.

Diagnostic value of noninvasive combined fluorine-18 labeled fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography enterography in active Crohnʼs disease

“…[24][25][26] Seven of 41 (17%) patients underwent surgery in our cohort, which is slightly lower than recent studies. 27 Our analysis revealed that the presence of multiple segments alone did not correlate with failed medical therapy, 57% (4 of 7 failed medical therapy) versus 35% (8 of 23 responded to medical therapy).…”

Factors Associated with Operative Recurrence Early After Resection for Crohn’s Disease

“…Previous studies 1,6,7,9,20,21 have shown that several risk factors, such as young age, female gender, smoking history, perianal disease, extent of disease, number of sites involved, and inadequate medical therapy, may increase the risk of operative recurrence. However, these were not associated with the timing of recurrence in our study.…”

“…20 Details pertaining to the use of suppressive medication were available and comparable in both the early and late operative groups prior to the repeated operation. A further potential weakness of the study may be related to the small number of patients in the subgroups that may have precluded the derivation of a P value that was significant.…”

A Comprehensive Review of Strictureplasty Techniques in Crohn’s Disease: Types, Indications, Comparisons, and Safety

“…Overall, the perioperative complication rate reported by most authors spans from 0% to 57% and averages 13%. [26][27][28][29][30][31] Data for procedure-specific recurrence rates are available only for a few strictureplasty techniques. In one study, Michelassi's 32 side-to-side isoperistaltic strictureplasty was shown to have a recurrence rate of 23%.…”