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Surgical aspects of Crohn's diseases
13rd Department of Surgery, Semmelweis University Medical School, Budapest, Hungary.
Insights
Crohn's disease frequently causes complications like ileus and fistulas, often requiring surgery. Recurrence rates are high, making long-term prognosis uncertain even after surgical intervention.
Area of Science:
- Gastroenterology
- Abdominal Surgery
Background:
- Crohn's disease is an inflammatory bowel disease known for frequent and diverse abdominal complications.
- Complications increase with disease duration, significantly impacting patient outcomes.
Purpose of the Study:
- To review the common complications of Crohn's disease, including ileus and fistulas.
- To discuss the therapeutic strategies, both surgical and conservative, for managing Crohn's disease complications.
- To analyze surgical outcomes, mortality rates, and recurrence patterns.
Main Methods:
- Review of existing literature on Crohn's disease complications and their management.
- Analysis of complication frequencies, surgical interventions, and recurrence data.
Main Results:
- Ileus (45%) and fistulas (29%) are the most frequent complications.
- Surgical intervention is indicated for life-threatening complications or failed conservative treatment.
- Surgical mortality is 4.1%, with recurrence rates of 28-33.3% and a second operation mortality of 18.6%.
Conclusions:
- Crohn's disease management requires careful consideration of complications and recurrence risks.
- Surgical interventions, while effective, are associated with significant morbidity and recurrence rates.
- Long-term prognosis for Crohn's disease remains uncertain due to the potential for late recurrences.
Abstract:
There is no other abdominal disease with so frequent and diverse complications as Crohn's disease. One of the most frequent complications is ileus (45%) due to the deflection and stricture of a bowel segment caused by inflammation and granulation. Fistulas--often multiple--between the involved bowel segment(s) and the hollow organs are also frequent (29%). The probability of complications increases with the duration of the disease. If they are life-threatening, the therapy is unequivocally surgical. The conservative treatment of some non-life-threatening complications may be attempted. Surgery is justified only if the complication is life-threatening or a long-lasting active conservative treatment has been proved unsuccessful. The most frequently employed surgical solution is resection of the involved bowel segment(s), recently stricture plasty. Surgical mortality is 4.1%. A characteristic feature of the disease is the frequency of recurrences (28% and 33.3%, respectively). The mortality of the second operation is 18.6%. Prognosis is always uncertain, since recurrences may appear many years after the surgical intervention.