Clinical experience with Crohn's disease

To determine the clinical spectrum of Crohn's disease in a surgical practice, and to show the safety and efficacy of the range of procedures performed.

A consecutive series of 92 patients with Crohn's disease who presented between January 1988 and August 2001 to a surgical practice were studied.

Ninety two patients (42 male, 50 female), with a mean age of 43 years (range 19-91 years) underwent surgery between January 1998 and August 2001. The mean length of follow up was 46 months (range 1-166 months). Forty patients had disease in more than one site, compared with 52 patients with single site disease. In total, 184 procedures were performed. Patients with the combination of colonic and anorectal disease required more surgical interventions than patients with other disease distributions. At follow up, all patients with disease confined to the small intestine or ileocaecal region were free of symptoms with the only nine taking medication. No patients presenting with colonic disease had symptomatic disease or were taking any anti-inflammatory medication at time of follow up. However, in the group of patients with anorectal or the combination of colonic and anorectal disease, 42% had ongoing symptoms (predominantly anorectal). Fifteen patients had a stoma at some point during their surgical course.

In a tertiary referral setting, surgical treatment of Crohn's disease can carry a low morbidity with good relief and control of symptoms when used for specific indications. Those with small bowel or colonic disease have better outcomes following surgery compared to those with anorectal disease.