Diminishing lengths of subsequent bowel resections in the surgical management of ileal Crohn's disease.

Abstract

Crohn's disease is a chronic inflammatory bowel disease that most commonly affects the ileum. As a result, it is associated with a high lifetime risk of one or more surgical resections. The surgical paradigm is to preserve intestinal length. This study aims to assess the length of ileum resected at the index operation and at subsequent ileocolic resections for Crohn's disease. This is a retrospective study assessing the clinical and pathological data of patients undergoing ileocolic resection for the management of Crohn's disease over the period 01/01/2002 to 31/07/2020 in two metropolitan Australian hospitals. One hundred and seventy-six patients were analysed: 130 underwent a single resection; 31 underwent two resections; and 15 underwent three resections. The median age at the first operation was 37.2 years (range 18-69) with 60% of patients female. The median length resected at the first surgery was 17.8cm (IQR 12.0) for small bowel, and 5.0cm (IQR 1.0) for large bowel. The length of ileum resected at the first surgery was significantly greater than that of the second (P= 0.0001), without significant differences between the second and third resections (P= 0.49). The time interval from diagnosis to the first surgery had no significant impact on the length of intestine resected at the index ileocolic resection. In Crohn's disease, the length of ileum removed at first resection is the greatest, with subsequent resection lengths less than the first.