Preoperative total parenteral nutrition (TPN) in severe Crohn's disease

This study was performed to evaluate the effect of preoperative total parenteral nutrition (TPN) on the results after surgical treatment of patients with severe Crohn's disease. Of 67 patients admitted with complications of Crohn's disease, 51 had severe active disease and abdominal masses, fistulas and/or obstruction (mean Crohn's disease activity index score, 301). Forty-four patients received preoperative TPN for a mean period of 33 days. Complications of TPN were limited. Spontaneous closure of fistulas was achieved in 75% of the cases. Serum albumin levels improved significantly, from 29.1 +/- 1.1 gm/L to 35.4 +/- 0.7 gm/L (p less than 0.001). Mean body weights improved from 81% to 89% ideal body weights or 52.6 kg to 57.2 kg, respectively (p less than 0.05). Surgical procedures were facilitated by remission of the active inflammatory process and associated with a major complications rate of only 6%. No deaths occurred. the mean hospital stay for the TPN-treated group of patients was 63 days. TPN is an effective preoperative treatment for patients with severe complicated Crohn's disease. The prolonged hospital stay and high costs, however, are disadvantages of this approach. Preoperative TPN treatment should therefore be limited to patients with severe active disease.