THE IMPACT OF DISEASE PATTERN, SURGICAL-MANAGEMENT, AND INDIVIDUAL SURGEONS ON THE RISK FOR RELAPAROTOMY FOR RECURRENT CROHNS-DISEASE

Objective The authors provide a multivariate analysis of a large singl e-center experience with limited surgery for Crohn's disease. Summary Background Data During the past decade, the aim of surgery for Crohn's disease has shifted from radical operation, achieving inflammation-fr ee margins of resection, to ''minimal surgery,'' intended to remove ju st grossly inflamed tissue or performing strictureplasties. Methods Se ven hundred ninety-three cases of resection and/or strictureplasty in 689 individuals with histologically verified Crohn's disease were foll owed for a mean period of 50 months (range, 5-166 months). Two differe nt end points were analyzed: 1) any relaparotomy for recurrent (or per sistent) Crohn's disease and 2) relaparotomy for site-specific recurre nce. More than 30 variables of patient/disease characteristics and sur gical management were included in a proportional hazard model. Results Five parameters were associated independently with the risk for relap arotomy: increased risk coincided with young age at onset of disease, involvement of jejunum, enterocutaneous fistula, or performed strictur eplasty, and decreased risk followed ileocecal resection. Site-specifi c risks of reoperation were calculated on the basis of 1260 intestinal resections or anastomoses performed in these patients. Young age at o nset, duodenal and jejunal involvement, presence of enterocutaneous or perianal fistula, and a single surgeon (of 23) were associated signif icantly with increased risk of regional recurrence but not stricturepl asty or inflammation at margins of resection. Conclusions Limited surg ery for Crohn's disease is not associated with increased risk of regio nal recurrence requiring reoperation. However, patients with juvenile onset, proximal small bowel disease, and some types of fistulae are at a considerable risk of experiencing early surgical recurrence.