Shortening and preservation of intestinal length through repeated operations in crohn's disease

Abstract

BACKGROUND AND PURPOSE : In surgical treatment for Crohn ' s disease, short bowel syndrome as a result of repeated intestinal resection is a serious complication. Measuring the length of small intestine, we evaluated the prognosis and the shortening of intestine. METHODS: A total of 119 operations were performed ; initial operation was done in 66 patients (resection only in 33, combination with strictureplasty in 33), the second operation in 39, and the third operation in 14. Using a 5Ocm-Iong thread and a ruler, total length of small intestine and the site of disease was assessed just after laparotomy, and retained intestinal length was measured before closure. The length of resected small intestine was measured after fixation. For the control, the length of small intestine was measured in 26 patients with ulcerative colitis and 4 with familial polyposis coli. _ RESULTS: Total length of small intestine at initial operation was 439 :!: 113 (rnean z SD) cm, 289 :!: 83 em at the second operation, and 244 :!: 69 cm at the third operation . The extent of the disease and the length of resected intestine was significantly (p<0.05) shortened at the second and the third operation compared with at initial operation. At initial operation, there were no differences in total intestinal length, the length of resected intestine, or the length of retained intestine between the resection and the strictureplasty group. At the second operation, the length of the resected intestine was remarkably (p<0.05) shortened in the strictureplasty group (5 :!: II cm) compared with resection group (24 :!: 22 cm). The total length of intestine at the second operation (302 :!: 84 ern) was significantly shorter than the length of retained intestine at the initial operation (395 :!: 157 ern) in the same patients (n= 20) (p<0.05l.CONCLUSIONS : Repeated surgical approach did not show disappointing results, because the extent of the disease got reduced as well as the length of intestine to be resected . Strictureplasty was useful to preserve the length of the intestine especially at the second operation. The shortening of the intestine was observed between the initial and the second operation.