Factors Determining Recurrence following Surgery for Crohn's Disease

Wolff, Bruce G.

doi:10.1007/s002689900398

Cited by 52 publications

(37 citation statements)

References 45 publications

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“…Therefore, anastomosis and strictureplasty can also be performed in macroscopically inflamed areas of bowel [12, 16]. Although inflamed bowel persists by using the strictureplasty technique, there is no higher rate of local recurrence [2]. This finding in our study is in agreement with the findings of other authors and studies.…”

Section: Discussionsupporting

confidence: 83%

“…Strictureplasty and limited resections are likely to prevent short-bowel syndrome even if repeated surgical procedures are required in the future, due to recurrence of the disease. In many studies it has been shown that strictureplasty is not likely to induce more recurrences than resection of the stenosis [2]. Today there is almost complete agreement that strictureplasty is a valuable technique in the treatment of small bowel strictures caused by Crohn’s disease [3, 4, 5, 6, 7, 8], at least for fibrotic strictures [9].…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Bröering¹,

Eisenberger²,

Koch³

et al. 2001

Dig Surg

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Background: Improvement in quality of life is one of the important determinants in the treatment of Crohn’s disease. Since there is no cure with radical resection of inflamed bowel, strictureplasty has become a useful surgical technique in the treatment of small bowel obstruction. The scope of this study was to define the results of strictureplasty and resection in terms of quality of life, surgical recurrence and postoperative complications. Methods: The charts of 67 patients with Crohn’s disease of the small bowel were analyzed retrospectively. Patients were treated either by strictureplasty (group A) or resection (group B). Quality of life was evaluated in follow-up examinations using the Inflammatory Bowel Disease Questionnaire (IBDQ). Results: Postoperative morbidity was 14.8% after strictureplasty and 17% after resection (p = 0.8). 50% of the patients treated by strictureplasty and 37% treated by resection developed recurrent disease (p = 0.40). Quality-of-life measurement revealed no significant difference between patients treated by strictureplasty or resection. Conclusion: Results after strictureplasty are comparable to those after resection in terms of complications, recurrence and quality of life in the treatment of small bowel strictures in Crohn’s disease. In the long run there might be an advantage for strictureplasty because it prevents complications caused by resectional therapy such as short bowel syndrome.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Bröering¹,

Eisenberger²,

Koch³

et al. 2001

Dig Surg

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“…There are conflicting data regarding the effect of microscopic disease at the resection margin [2]. However, given that Crohn's disease is a pan-intestinal disease, that it is focal in distribution, and that histological abnormalities have been demonstrated in segments of bowel which appear to be grossly normal, the significance of microscopic disease at the resection margin is questionable.…”

Section: Bowel Resectionmentioning

confidence: 89%

Surgery for Inflammatory Bowel Diseases

McLeod¹

2003

Dig Dis

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Surgery is required in many patients with inflammatory bowel disease at some point in their disease. In patients with ulcerative colitis, surgery is potentially curative whereas recurrence of Crohn’s disease following surgery is a common occurrence. As a result, the indications and surgical management of the two diseases may be quite different. Surgery is usually reserved for the management of complications or failure of medical treatment in Crohn’s disease. Resection of the diseased segment is the usual procedure performed. While surgery usually results in an improvement in quality of life, recurrence of disease occurs frequently with reported rates of 5–90% at 1 year, depending on the criteria used. To date, there have been no surgical maneuvers which have been shown to decrease the risk of recurrence. Over the past few decades, several advances have been made in the surgical management of Crohn’s disease: use of strictureplasty for extensive disease; use of laparoscopic techniques to perform surgery and the performance of the ileal pouch procedure in very selected patients. Significant advances in the surgical management of ulcerative colitis have been made in the past 50 years. Although there are several options available to patients, the preferred option now is the ileal pouch procedure. With technical modifications and with experience, this procedure can now be performed with a low complication rate, with good functional results and quality of life and excellent long-term outcome.

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“…Several factors such as age, onset of disease, gender, site of disease, number of resections, symptomatic status at the time of surgery, length of small bowel resection, proximal margin length, microscopic margin histology, type of anastomosis, type of surgery, blood transfusions, family history, and prophylactic treatment, were investigated for their supposed in uence in this phenomenon 13 . In the advanced, stenotic phase of CD, patients frequently present with recurrent episodes of partial small bowel obstruction.…”

Section: Discussionmentioning

confidence: 99%

Case Report of a Crohn's Disease (CD) Patient with Anastomotic Stenosis Unrelated to Postoperative Recurrence of CD

Umemoto

Yokomizo

Goto

et al. 2011

Showa Univ J Med Sci

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: Crohn s disease CD is an idiopathic in ammatory bowel disease that can involve any part of the gastrointestinal tract. It frequently involves the ileum, colon, and anorectum. A 66-year-old man with CD had undergone a partial intestinal resection of the ileum for CD 27 years previously, and had been hospitalized several times, including two months prior to referral. The patient was admitted to our hospital with abdominal pain and distension. A computed tomography CT scan demonstrated an anastomotic stenosis with active in ammation and proximal intestinal extension. Colonoscopic examination revealed no abnormalities in the colon or rectum. A contrast Gastrogra n enema revealed a stenosis in the ileum and a tight stricture at 3 cm with in ammation. We performed an ileocecal resection for an anastomotic stenosis due to possible recurrence of CD. Pathological examination showed no evidence of CD activity at the anastomotic region, indicating no recurrence of CD.

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Factors Determining Recurrence following Surgery for Crohn's Disease

Cited by 52 publications

References 45 publications

Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Quality of Life after Surgical Therapy of Small Bowel Stenosis in Crohn’s Disease

Surgery for Inflammatory Bowel Diseases

Case Report of a Crohn's Disease (CD) Patient with Anastomotic Stenosis Unrelated to Postoperative Recurrence of CD

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