Nutritional Factors in Timing and Preparation of Operation for Crohn's Disease

Abstract

The combination of active abdominal disease with fistulas and poor nutritional status may be associated with a high complication rate and even mortality after surgical treatment of patients with Crohn's disease. This study was performed to evaluate the effect of preoperative total parenteral nutrition on the results of surgical treatment of patients with severe Crohn's disease. Forty-four of 67 patients admitted with complications of Crohn's disease (with abdominal masses, fistulas, and/or obstruction; mean CDAI score 301) received preoperative total parenteral nutrition for a mean period of 33 days. Spontaneous fistula closure was achieved in 75%. Serum albumin levels improved significantly from 29.1 g/1 to 35.4 g/1 (p <001). Mean body weight improved from 81% to 89% ideal body weight. Surgical procedures were facilitated by remission of the active inflammatory process and were associated with a complication rate of 5% and no mortality. In more than 90% of patients undergoing surgery irreversibly stenosed bowel segments were resected with primary anastomosis. Total parenteral nutrition is an effective preoperative treatment in patients with severe complicated Crohn's disease.