Comparison of index and reoperative bowel resections in Crohn's disease

There is a scarcity of literature describing outcomes of reoperative Crohn's disease. An in-depth knowledge of these outcomes is critical for managing patient expectations and optimal perioperative planning. We sought to examine outcomes in patients undergoing reoperative surgeries for Crohn's disease compared to index operations.

A retrospective chart review of surgeries performed from 2018-2023 at a single tertiary care academic institution was performed. A subgroup analysis of index vs. reoperative ileocolic resections was performed to minimize confounding due to the heterogeneity of operations between the index and reoperative groups.

Out of 119 patients, 70 (59%) underwent index operations, and 49 (41%) were reoperations. Overall complication rates (24.28% vs. 34.69%, P=0.224), EBL (189.5 vs. 193.4 mL, P=0.94), operative time (209 vs. 236 min, P=0.091), length of stay (mean: 7.24 vs. 10.08 days, P=0.0142), utilization of laparoscopy (92.85% vs. 65.3%, P=0.0002) and conversion to open technique (4.61% vs. 9.37%, P=0.392) favored index cases. The laparoscopic approach narrowed the gap in length of stay between the index and reoperative groups from 2.83 to 0.6 days. Subgroup analysis of ileocolic resections (Index: 50, reoperations: 26) also favored the index operations.

The current study provides valuable insight into managing patient expectations and optimal perioperative planning for reoperative Crohn's disease. Reoperations were associated with longer stays, lower utilization of laparoscopic platforms, and a trend toward higher overall complication rates. Laparoscopy reduces the gap in length of stay between index and reoperations; however, it is associated with a higher reoperation conversion rate.