THE MINIMAL BOWEL RESECTION IN CROHN’S DISEASE: ANALYSIS OF PROGNOSTIC FACTORS ON THE SURGICAL RECURRENCE

Abstract

Objective: To assess the effect of disease pattern and involment of the margins on early and late results of enteric resections with hand-sewn anastomosis for Crohn’s disease.

Background: Bowel sparing is one of the aims of the surgery for CD. When strictureplasties are not possible, “minimal surgery” (the resection just of the grossly involved tract of bowel) is the current choice.

Methods: One hundred and forty-six cases of resections in 128 patients were performed in the years 1991-2001. We investigated if there is a relationship between disease pattern (perforating and non-perforating) or hystologic involvement of the margins and recurrence (reoperation for recurrent preanastomotic disease). Hand-sewn anastomosis were performed almost in all the cases; we compared the results with the main series of stapled and hand-sewn sutures.

Results: Nine surgical complications occurred (7%), requiring six relaparotomies and three conservative treatments. Overall rate of recurrence (median follow-up 44 months) is 17%: 9% in patients with non perforating disease and 19% in patients with perforating disease. The rate of recurrence is 6% in the group of patients with involved margins and 23% in the group with non involved margins.

Conclusions: Limited surgery for CD doesn’t increase rate of recurrence; the involvement of margins is not a risk factor for early reoperation. Hand-sewn anastomosis seem to be as safe as stapled ones.