[Surgical treatment of recurrent Crohn's disease]

According to the literature, the incidence of Crohn's disease is 6.0:100,000, and the prevalence is 50.0-60.0:100,000. The prevalence in this countries 3.2:100,000 and the characteristics of the disease are: a more benign course, better prognosis and infrequent involvement of the colon. The incidence of recurrence is 40.0% during a 5 year period and 65% during a 10 year period. Practically, every patient operated for Crohn's disease will be reoperated once during the first five postoperative years. The experience of the authors indicates that the situation in this country is considerably better. During the period ranging from 1980-1992, a total of 70 patients were operated for Crohn's disease. In this group of operated patients 24 (34.40%) had recurrent symptoms. Seven patients (10.0%) in the series, operated at an earlier date at this Institution, were reoperated for Crohn's disease. Another 8 patients (11.43%) were also reoperated for Crohn's disease in this series, but their initial operation had been done at a different Institution (palliative or inadequate prior surgery). Indications for reoperation did not differ from indications for the initial operation: existence of surgical complications. The most important factors in the surgical management of recurrence are: assessment of disease activity and progression and adequate preoperative and postoperative nutrition in order to improve the immune response, which is often impaired by previous surgery, disease activity and inadequate management. Correct operative strategy is crucial. The authors, in both initial and reoperations, perform limited resection of the small intestine, generous resection of the large intestine and stricturoplasty and divergent stomas on the small intestine.(ABSTRACT TRUNCATED AT 250 WORDS)