Abstract
There has been great controversy about the proper role of operation in the management of colonic Crohn's disease because of disagreement about the frequency of recurrence. Since, in our retrospective studies, the majority of patients with colonic Crohn's disease had a previous diagnosis of ulcerative colitis, accurate determination of the recurrence rate in colonic Crohn's disease requires review of all patients with colonic inflammatory bowel disease in order to define the population at risk. Using objective means for diagnosis and for the assessment of outcome, we have found that recurrent disease after ileostomy and colectomy occurred in a minority (approximately 16%) of the patients. Both Crohn's colitis and ulcerative colitis followed a generally favorable postoperative course after this procedure, since even those patients who developed recurrent disease usually were rehabilitated by one or more revisions of the ileostomy. We believe that needed operations should not be avoided solely because of a diagnosis of colonic Crohn's disease, since the high recurrence rates and poor prognoses reported in many studies are based on faslely low numbers of those at risk.
Résumé
Le traitement chirurgical de la maladie de Crohn reste controversé parce que la fréquence des récidives est mal connue. Dans nos études rétrospectives, la majorité des patients atteints de maladie de Crohn colique avaient eu un diagnostic pré-opératoire de colite ulcéreuse. Il faut donc, pour définir la population et déterminer avec exactitude le risque de récidive, revoir tous les cas de maladie inflammatoire de l'intestin. En utilisant des critères objectifs, tant pour le diagnostic que pour le pronostic, nous avons constaté une fréquence de récidives faible après colectomie et iléostomie (±16%). Dans la maladie de Crohn colique et dans la colite ulcéuse, les résultats de l'opération sont en général favorables: même les récidives sont souvent guéries après une ou plusieurs révisions de l'iléostomie. Nous estimons qu'il ne faut pas, sous prétexte qu'il s'agit d'un Crohn colique, refuser une opération nécessaire, car les fréquences élevées de récidives et les mauvais pronostics sont, dans de nombreuses études, basés sur des séries trop restrictives éliminant bon nombre de cas qui devraient être inclus dans l'étude pronostique.
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Glotzer, D.J. Recurrence in Crohn's colitis: The numbers game. World J. Surg. 4, 173–180 (1980). https://doi.org/10.1007/BF02393571
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DOI: https://doi.org/10.1007/BF02393571