A novel surgical classification system for ileocolic Crohn's disease: "It is not just ileocolic disease"

Crohn's disease (CD) often affects the terminal ileum, leading to complications such as stricture, fistula, and abscesses, necessitating surgery in up to 80% of patients. Early and effective treatment is crucial to prevent disease progression and improve outcomes, although timing between medical and surgical treatments is challenging.

This study reviewed patients who underwent ileocolic resection for CD at our quaternary inflammatory bowel disease center from September 2016 to September 2023. A novel classification system categorized the severity and complexity of ileocolic CD. Preoperative characteristics, operative variables, and postoperative outcomes were analyzed to assess the impact of disease complexity.

Among the 301 patients (median age 33.3 years, 48.5% female), 56.8% had complex ileocolic CD. Complex disease was associated with greater blood loss, longer hospital stays, longer operative time, and greater rates of open surgery and conversion compared with noncomplex disease (P < .01). Diversion rates were significantly greater in complex cases (P < .01). Emergent operations were more common among complex cases (P < .01). Delayed referral and increased complexity correlated with inferior surgical outcomes and greater stoma rates.

The proposed classification system stratifies patients on the basis of CD severity and complexity, facilitating better preoperative planning and communication among multidisciplinary teams. Early surgical intervention, when appropriate, may reduce morbidity and improve outcomes in patients with ileocolic CD. This system highlights the importance of timely referrals and standardizing the management approach for complex CD.