Abstract
BackgroundRepeated intestinal resections may have disabling consequences in patients with Crohn’s disease even in the absence of short bowel syndrome. Our aim was to evaluate the length of resected small bowel in patients undergoing elective and emergency surgery for ileocolic Crohn’s disease.MethodsA prospective observational study was conducted on patients undergoing surgery for ileocolonic Crohn’s disease in a single colorectal centre from May 2010 to April 2018. The following patients were included: (1) patients with first presentation of ileocaecal Crohn’s disease undergoing elective surgery; (2) patients with ileocaecal Crohn’s disease undergoing emergency surgery; (3) patients with recurrent Crohn’s disease of the distal ileum undergoing elective surgery. The primary outcomes were length of resected small bowel and the ileostomy rate. Operating time, complications and readmissions within 30 days were the secondary outcomes.ResultsOne hundred and sixty-eight patients were included: 87 patients in the elective primary surgery group, 50 patients in the emergency surgery group and 31 in the elective redo surgery group. Eleven patients (22%) in the emergency surgery group had an ileostomy compared to 10 (11.5%) in the elective surgery group (p < 0.0001). In the emergency surgery group the median length of the resected small bowel was 10 cm longer than into the group having elective surgery for primary Crohn’s disease.ConclusionsPatients undergoing emergency surgery for Crohn’s disease have a higher rate of stoma formation and 30-day complications. Laparoscopic surgery in the emergency setting has a higher conversion rate and involves resection of longer segments of small bowel.
Highlights
Over 80% of patients diagnosed with primary ileocolic Crohn’s disease (CD), who are typically young adults, have a surgical resection within 10 years of their diagnosis [1]
Short bowel syndrome is a rare sequela of repeated surgical resection for CD, with a cumulative risk of home parenteral nutrition of 1.5% at 20 years after diagnosis [4]
Patients undergoing redo surgery for recurrent CD were more than 10 years older than patients undergoing primary resection, as expected, and more male patients underwent redo surgery compared to primary and emergency surgery
Summary
Over 80% of patients diagnosed with primary ileocolic Crohn’s disease (CD), who are typically young adults, have a surgical resection within 10 years of their diagnosis [1]. Repeated intestinal resections leading to impaired gastrointestinal functioning with nutritional and vitamin deficiencies may have disabling consequences for the patients even in the absence of short bowel syndrome. Repeated intestinal resections may have disabling consequences in patients with Crohn’s disease even in the absence of short bowel syndrome. Our aim was to evaluate the length of resected small bowel in patients undergoing elective and emergency surgery for ileocolic Crohn’s disease. The primary outcomes were length of resected small bowel and the ileostomy rate. In the emergency surgery group the median length of the resected small bowel was 10 cm longer than into the group having elective surgery for primary Crohn’s disease. Conclusions Patients undergoing emergency surgery for Crohn’s disease have a higher rate of stoma formation and 30-day complications. Laparoscopic surgery in the emergency setting has a higher conversion rate and involves resection of longer segments of small bowel
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