The operative management of Crohn Disease

The natural history of Crohn disease* is varied and unpredictable, and its cause is not known. No modality of treatment has definitely been shown to alter its course. Surgical treatment was carried out in a consistent fashion in 141 consecutive patients with Crohn disease. The indications for surgical operation were the complications of the disease only; these included fistula, abscess, obstruction and hemorrhage. Preoperative evaluation included upper gastrointestinal examination, barium enema, intravenous pyelogram, proctoscopy, and nutritional and volume support. In 76 of these patients previous operations had been carried out for Crohn disease. The surgical treatment was based upon the specific complication present, with adherence to the principle of resection of diseased tissue only. Ureterolysis also was necessary in 20 percent of these patients. The operative mortality was 1.4 percent, postoperative complications occurred in 54 patients and the surgical recurrence rate was 26 percent. A favorable result was accomplished in 85 percent of the patients.