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Surgical relations of Crohn's disease and the frequency of recurrence
1Third Surgical Department, Semmelweis University Medical School, Budapest, Hungary.
Insights
Crohn's disease frequently causes complications like bowel obstruction and fistulae, often requiring surgery. Recurrence is common, leading to a poor prognosis, with surgical intervention rates low in Hungary.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Crohn's disease presents numerous and diverse complications.
- Bowel obstruction and fistulae are among the most frequent complications.
- Complication frequency escalates with disease duration.
Purpose of the Study:
- To review the complications of Crohn's disease.
- To discuss surgical interventions for Crohn's disease.
- To analyze surgical outcomes and recurrence rates.
Main Methods:
- Literature review of Crohn's disease complications and surgical management.
- Analysis of complication types including bowel obstruction and fistulae.
- Evaluation of surgical intervention outcomes, mortality, and recurrence.
Main Results:
- Bowel obstruction occurs in 32.3% of cases; fistulae in 11.3-14.4%.
- Surgical treatment is necessary for life-threatening complications or treatment failure.
- Operative mortality is 3.7%, influenced by disease duration and complication count.
- Recurrence rates range from 30.1-34.9%, with a 17.5% mortality for second operations.
Conclusions:
- Crohn's disease complications significantly impact patient prognosis.
- Surgical interventions, while necessary, carry risks including mortality and high recurrence rates.
- The rate of surgically treated Crohn's disease patients in Hungary is notably low (0.06%).
Abstract:
There is no disease that would have as many and variable complications as Crohn's disease. One of the most common complications is bowel obstruction which can be caused by the angulation of the bowel or by inflammation, or by formation of granulation tissue (32.3%). Very common is the formation of fistulae amongst the bowels involved and other abdominal organs, and also entero-cutaneous fistulae occur frequently (11.3-14.4%). The frequency of complications is increasing with the duration of the illness. If they are life-threatening, only surgical treatment can help. Surgical treatment is also indicated when conservative treatment fails. The most commonly used surgical interventions are bowel resection and, recently, the plasty of stenotic areas. The operative mortality (3.7%) is influenced by the length of the disease and by the numbers of complications. Recurrence is very common in Crohn's disease (30.1-34.9%). The mortality rate of the second operation is 17.5%. The prognosis is usually poor because recurrence can occur years after the primary operation. In Hungary, the frequency of surgically treated patients with Crohn's disease is low, they count for 0.06% of all general surgical operations.