No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn\u2019s Disease

Jiajie Zhou,Weiming Zhu,Yi Li,Jianfeng Gong

doi:10.1038/s41598-018-34867-w

Jiajie Zhou, Weiming Zhu + Show 2 more

Open Access

https://doi.org/10.1038/s41598-018-34867-w

Copy DOI

Abstract

The aim of this study was to investigate the impact of staging operation on the risk of reoperation in patients with CD who underwent primary bowel resection. This was a retrospective study of 980 patients with CD who were hospitalized in Jinling Hospital Affiliated to Nanjing Medical University between January 1, 2001, and October 1, 2016. The patients were grouped according to staging operation (n = 64) and one-stage operation (n = 148). Postoperative intestinal function recovery time, postoperative short-term complications, and reoperation rates were compared between the two groups. There was significant difference in disease behavior between the staging operation group and the one-stage operation group. There was no significant difference in postoperative tolerance of enteral nutrition among groups (P > 0.05). Obvious differences were found in the comparison of the first time of exhaustion, defecation after operation, postoperative length of stay and postoperative complications among groups (all P < 0.05). There was no difference in the 5-year cumulative reoperation-free rates between the two groups (P > 0.05). In conclusion, surgical intervention at proper time and appropriate operation during operation are essential for patients with CD. It is believed that staging operation with ostomy followed by intestinal anastomosis is feasible when there are more than two risk factors for postoperative intra-abdominal infectious complications.

Highlights

Crohn’s disease (CD) is a chronic inflammatory granulomatous disease of the intestines with lifelong relapse
For patients undergoing emergency operation and with poor nutritional status or severe intraoperative abdominal contamination, staging operation was adopted by using one-stage temporary ostomy and two-stage intestinal anastomosis
For patients who required temporary ostomy, abdominal abscess drainage or diseased intestinal resection would be performed during operation, and enteral nutrition support was given early after operation

Summary

Introduction

Crohn’s disease (CD) is a chronic inflammatory granulomatous disease of the intestines with lifelong relapse. CD patients required surgical treatment have CD complications that need to be managed by surgery, and suffer from malnutrition caused by long-term intestinal dysfunction and immune disorders due to long-term administration of drugs. The principle of surgical treatment for CD is to control the symptoms, and corresponding operative modes include diseased intestinal resection, ostomy and drainage of abdominal abscess, etc. When the whole-body situation of the patient is not allowed to perform major incision, surgical treatment in accordance with the concept of “damage control surgery (DCS)” can reduce the risk of treatment to a certain extent and improve corresponding clinical effect. The present study was conducted to explore the effect of staging operation on postoperative reoperation rate of CD patients. The results of this study may be beneficial for optimizing the therapeutic regimen and improve the quality of life in CD patients postoperatively

Objectives

Methods

Results

Conclusion