Surgery for Crohn's disease in Greece: A follow-up study of 79 cases

Background/Aims: The aim of this prospective study was to elucidate the cli nical features, indications for surgery and long-term outcome of a series o f 79 Greek patients operated on for Crohn's disease. Methodology: The clinical features and follow-up of 79 out of 155 patients with definite diagnosis of Crohn's disease (51%), who were operated on at l east once during the course of their disease, are analyzed. Three main loca tions of the disease were identified (small bowel, large bowel and small an d large bowel). The need for surgery, indications for surgery and outcome o f patients were analyzed and compared separately for these three main locat ions. The mean follow-up period after the first operation was 8.8 +/-6.5 ye ars. Results: The proportion of men to women was 1.55:1 (P=0.068). The main indi cation for surgery was poor response to conservative treatment, followed by obstructive ileus, erroneous diagnosis of acute appendicitis and developme nt of fistulae or abscesses. Statistically significant differences between the three main locations of the disease were found for obstructive ileus (P <0.01), and bowel perforation (P <0.0297). Enterectomy and end-to-end anas tomosis was the most frequently performed operation. Minor surgical procedu res were performed mainly for drainage of perianal abscess. Differences in the number of operations required (one, two and three or more) according to the three main locations of the disease were statistically significant (P <0.044). Emergency operation was required in 17.3%. Most of the urgently op erated patients had only small bowel involvement. Twenty-six percent of pat ients required a surgical procedure for perianal disease. One or more, majo r or minor, perioperative complications occurred in 13 out of 79 operated p atients (16.4%). No perioperative deaths were noticed. Evolution to cancer was observed in 2% (3 patients). The outcome of patients after the operatio n was characterized by exacerbations and remissions. A mortality rate of 11 .6% was noticed in the follow-up period. However, most deaths were unrelate d to the underlying Crohn's disease. Conclusions: The clinicoepidemiological characteristics of patients with Cr ohn's disease of Greek origin operated-on for their disease do not differ s ignificantly from those reported from other Western or neighboring Mediterr anean countries. However, other parameters such as the relatively low incid ence of overall surgical need, the low incidence of colorectal cancer and t he low incidence of surgery for perianal disease, all underline the importa nce of various genetic and environmental factors on the evolution and behav ior of the disease in different parts of the world.