International Journal of Colorectal Disease

, Volume 23, Issue 12, pp 1167–1174

Intraabdominal septic complications following bowel resection for Crohn’s disease: detrimental influence on long-term outcome

  • Igors Iesalnieks
  • Alexandra Kilger
  • Heidi Glaß
  • Rene Müller-Wille
  • Frank Klebl
  • Claudia Ott
  • Ulrike Strauch
  • Pompiliu Piso
  • Hans J. Schlitt
  • Ayman Agha
Original Article

DOI: 10.1007/s00384-008-0534-9

Cite this article as:
Iesalnieks, I., Kilger, A., Glaß, H. et al. Int J Colorectal Dis (2008) 23: 1167. doi:10.1007/s00384-008-0534-9
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Abstract

Background

A number of studies deal with factors affecting postoperative recurrence; however, they do not analyze the influence of postoperative morbidity on the long-term outcome. This was the aim of the present study.

Materials and methods

Two hundred eighty-two patients underwent 331 intestinal resections for primary or recurrent Crohn’s disease between 1992 and 2005. Closure of ileostomy or colostomy, isolated stricturoplasty, abdominoperineal resection for perianal disease, and reoperations for postoperative complications were excluded. “Surgical recurrence” was defined as a development of stricturing or perforating disease necessitating repeat surgical therapy.

Results

Anastomotic leak, intraabdominal abscess, enterocutaneous fistula (intraabdominal septic complications, IASC) occurred after 46 operations (16%). Four patients died (1.2%). By multivariate analysis, articular disease manifestation (p = 0.03), duration of symptoms leading to surgery (p = 0.009), and weight loss (p = 0.03) were associated with occurrence of postoperative complications. Surgical recurrence occurred following 86 bowel resections, and 36 occurred during the first postoperative year. The following factors were associated with an increased risk of surgical recurrence by multivariate analysis: postoperative IASC (p = 0.0002) and previous bowel resections (p = 0.002). Patients suffering IASC had statistically significantly higher 1-, 2-, 5-, and 10-year surgical recurrence rate (25%, 29%, 50%, and 57%) than patients without IASC (4%, 7%, 19%, and 38%, p = 0.0003).

Conclusion

The incidence of the postoperative IASC is predominantly determined by preoperative disease severity. IASC have a detrimental influence on the long-term outcome following intestinal resections in patients with Crohn’s disease, leading to increased number of repeat resection surgery.

Keywords

Crohn’s diseaseSurgeryPostoperative complicationsLong-term outcomeRecurrence

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Igors Iesalnieks
    • 1
  • Alexandra Kilger
    • 1
  • Heidi Glaß
    • 1
    • 2
  • Rene Müller-Wille
    • 3
  • Frank Klebl
    • 4
  • Claudia Ott
    • 4
  • Ulrike Strauch
    • 4
  • Pompiliu Piso
    • 1
  • Hans J. Schlitt
    • 1
  • Ayman Agha
    • 1
  1. 1.Department of SurgeryUniversity of RegensburgRegensburgGermany
  2. 2.Pediatric PracticeBad KötztingGermany
  3. 3.Institute of RadiologyUniversity of RegensburgRegensburgGermany
  4. 4.Department of Internal Medicine IUniversity of RegensburgRegensburgGermany