[Indications of surgical treatment of Crohn disease]

Indications for surgery in Crohn's disease were studied in 100 consecutive cases. Cases included emergency situations (n = 22) complicated forms (n = 55) and chronic forms (n = 23). Lesions were located in the small bowel alone (n = 43), small and large bowel (n = 16) and in the colon and rectum (n = 16). During the same period, 26 reoperations were performed, there was no operative mortality and no short bowels were observed. A stomy was required in 30 cases and could be removed in 19. For lesions involving the small bowel, resections were limited to symptomatic lesions; long and short plasties were performed with no complications. For the colon, total and segmentary colectomy was performed for 18 cases and ileorectal anastomoses in 13. Five proctectomies were required. Rectal exclusion was considered as a wait and see solution which was long in several cases with severe rectoperineal lesions. In these cases, secondary proctectomy should be widely proposed. For emergency situations, it would be prudent to use a safe operative technique with wide indication for stomies. For complicated forms, careful preparation allows for complete procedure with one operation. For chronic forms resistant to medical treatment, the decision can be rather difficult, but the fact that recurrences do exist should not mask the long-term remissions obtained in half the cases with surgery.