Journal of Gastrointestinal Surgery

, Volume 11, Issue 12, pp 1692–1698 | Cite as

Clinical Factors Contributing to Rapid Reoperation for Crohn’s Disease Patients Undergoing Resection and/or Strictureplasty

  • David G. Binion
  • Kenneth R. Theriot
  • Sushrut Shidham
  • Sarah Lundeen
  • Ossama Hatoum
  • Hyun J. Lim
  • Mary F. Otterson
Article

Abstract

Although surgically induced remission of Crohn’s disease following segmental resection/strictureplasty is effective and durable, a subpopulation of patients will require rapid reoperation. We reviewed our inflammatory bowel disease center’s database to identify patients who underwent multiple laparotomies. A retrospective analysis of consecutive Crohn’s disease patients (1998–2004) was performed, and patients requiring repeat laparotomy were identified. Rapid reoperation was defined as repeat intestinal surgery within 2 years. Demographic data and medical treatment were recorded. Clinical factors contributing to rapid reoperation were defined as (1) symptomatic adhesion, (2) residual strictures/technical error, (3) lack of effective medical therapy, and (4) severe disease despite medical treatment. Of 432 patients, 65 required two or more abdominal explorations, with 32 patients requiring rapid reoperation (50 surgeries). Residual strictures and technical error accounted for 20% of procedures; ineffective medical therapy was identified in 64%, whereas severe disease despite medical therapy was a contributing factor in 14%. Adhesions were found in a single patient. Kaplan–Meier analysis confirmed that rapid reoperation patients had significant and consistently shorter intervals between surgical procedures (i.e., interval between procedures 1 and 2 and 2 and 3). Residual strictures manifest during postop year 1, whereas recurrence of severe disease was the dominant contributing factor during year 2. Our data suggest that operative strategies emphasizing occult stricture detection and adequate medical therapy in Crohn’s disease patients may improve outcome and decrease the need for rapid re-exploration.

Keywords

Crohn’s disease Surgery Strictureplasty Azathioprine 6-Mercaptopurine Methotrexate Infliximab Adhesions Complications 

Notes

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Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • David G. Binion
    • 1
  • Kenneth R. Theriot
    • 1
  • Sushrut Shidham
    • 2
  • Sarah Lundeen
    • 3
  • Ossama Hatoum
    • 1
  • Hyun J. Lim
    • 4
  • Mary F. Otterson
    • 3
  1. 1.Division of Gastroenterology and Hepatology, Department of Medicine, Digestive Disease Center, Froedtert Hospital, Milwaukee VA Medical CenterMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of Pathology, Digestive Disease Center, Froedtert Hospital, Milwaukee VA Medical CenterMedical College of WisconsinMilwaukeeUSA
  3. 3.Department of Surgery, Digestive Disease Center, Froedtert Hospital, Milwaukee VA Medical CenterMedical College of WisconsinMilwaukeeUSA
  4. 4.Division of Biostatistics, Digestive Disease Center, Froedtert Hospital, Milwaukee VA Medical CenterMedical College of WisconsinMilwaukeeUSA

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