CR03 *ILEOCOLIC RESECTIONS FOR CROHN'S DISEASE: IMPACT OF MEDICAL THERAPY

Abstract

Purpose: Ileocolic resection is the commonest surgical resection performed for Crohn's disease. The aim of the study was to review outcomes of primary ileocolic resections for Crohn's disease with particular emphasis on complications, recurrence and impact of prophylactic medication.Methodology: Retrospective chart review was undertaken on all patients undergoing ileocolic resection for Crohn's disease between July 1998 and June 2008 at a tertiary centre. Data collected included patient demographics, pre‐operative medication, technical aspects of surgery, complications, prophylactic medical therapy and recurrence of disease.Results: There were 64 patients (28 male, 36 female), mean age 30.2 years (SD 10.6). Surgery was elective in 49 patients (76.6 %) and urgent in 15 (23.4%). Laparoscopic surgery was undertaken in 31 (48.4%) with 3 converted to open (9.7 %). High anterior resection was performed in addition in 9.4% for contiguous disease. Post‐operative complication rate was 17.2% (anastomotic leak 6.3%; intra‐abdominal abscess 4.7%; pulmonary embolus 3.1%; other 3.1%). Endoscopic disease recurrence occurred in 27 (42.2%) of patients with mean time to recurrence 1.8 years (SD 1.3). Surgical intervention for recurrent disease was required in 5 (7.8%) and 40% of these developed further recurrence on imaging after repeat surgery. Prophylactic medications following primary resection did not reduce risk of recurrence (recurrence [prophylaxis/no prophylaxis], 21 vs. 6; no recurrence, 26 vs. 11; p = NS).Conclusion: Almost half of patients who have an ileocolic resection for Crohn's disease will develop recurrence though less than 10% require further surgery. Prophylactic medical therapy does not reduce recurrence.