[Prevention of infectious postoperative complications in Crohn's disease]

Mortality and post-operative complications are elevated in Crohn's disease, for many reasons: pre-existing septic complications, malnutrition, impaired cell-mediated immunity, failure to identify enteric fistulas and/or abdominal abscess during surgical operation. From 1984 to 1996 in 383 patients with Crohn's disease we performed 426 surgical procedures, observing post-operative complications in 28 of these (6.5%). However, septic complications in the surgical field were only 7 (1.6%). A 83-year-old patient died after surgery because of heart failure. The risk of post-operative complications was significantly higher in patients with elevate Prognostic Nutritional Index (PNI). We treated patients with malnutrition pre-operatively using parenteral nutrition (TPN). In 100 patients undergoing TPN we observed a significant PNI reduction (from 53.3 +/- 13 to 42.1 +/- 6.9) and a significative improvement of transport proteins correlated with nutritional status, such as pre-albumin (from 21.2 mg/dl +/- 9.8 to 26.5 mg/dl +/- 7.8) and retinol binding protein (from 3.8 mg/dl +/- 1.6 to 4.6 mg/dl +/- 1.7). During surgical operations we recorded fistulas caused by disease, observing 336 fistulas in 258 patients. The treatment of fistulas (by suture or less frequently by resection of the intestinal tract involved in the inflammatory process) prevented septic post-operative complications: indeed we did not observe enteric fistulas in any patient post-operatively. We conclude that the improvement of nutritional status and the adequate treatment of enteric fistulas prevents septic complications in nearly all patients.