Pre- and Post-Operative Complications in Crohn's Disease with Special Reference to Duration of Preoperative Disease History

Abstract

In an analysis of a consecutive series of 133 patients with a diagnosis of Crohn's disease established preoperatively and in which early surgical intervention was the prevailing policy, the median time between diagnosis and operation was short. For patients with predominantly small-bowel disease it was 4 months and for patients with predominantly colonic involvement 8 months. The frequencies of preoperative and early postoperative complications were low compared with those in other reports. Local complications, such as intra-abdominal fistulae and abscesses, were preoperatively seen in only 4% of the patients. Arthritis, iritis, or erythema nodosum was not seen in patients with predominantly small-bowel disease. The early postoperative death rate was 1.5%, the late mortality rate related to Crohn's disease 2.3%. In conclusion, early resectional surgery seems to be justified as one form of treatment for Crohn's disease in that it diminishes the rate of serious complications. The risk of recurrence is, however, not influenced by early surgical intervention.

Early versus late surgery for ileo‐caecal Crohn’s disease

“…According to this observation, surgery appears to be the most effective therapeutic intervention for inducing sustained remission. Since 1970, some authors have advocated early surgery as the approach of choice in CD 18–21 . Early surgery may offer several advantages: the re‐operation rate for recurrent disease is not increased, 22–24 the quality of life of the patient improves greatly compared to prolonged disease activity and long‐term medical treatment, 25–27 and early resection, prior to the development of advanced or complicated disease, reduces post‐operative morbidity and, possibly, the extent of the resected specimen 20, 28, 29 .…”

Systematic review of postoperative complications in patients with inflammatory bowel disease treated with immunomodulators

“…Postoperative complication rates are higher in patients with Crohn's disease than in non‐inflammatory controls10–12. Among patients with Crohn's disease undergoing surgery, between 6 and 45 per cent have postoperative complications13, 14 and mortality rates range from 0·5 to 5·5 per cent15, 16. In patients with ulcerative colitis undergoing ileal pouch–anal anastomosis (IPAA), postoperative complications affect 19–58 per cent, the rate decreasing with the experience of the surgeon17–19.…”

Successful Treatment of Postoperative Fistula with Infliximab in a Patient with Crohn's Disease

“…They usually require multiple anastomoses, which results in higher mortality rates (0.5-5.5%) due to complications as compared to patients without CD. 5 - 7 Complications from surgery include wound infections, anastomotic leakages, fistulas, anastomotic site strictures, and sepsis in the pelvis.…”