La chirurgia conservativa della malattia di Crohn: risultati a lungo termine

INTRODUCTION: Patients with Crohn's disease (CD) receive one or more surgical interventions throughout their clinical history. Conservative surgery has recently been proposed as a safe and effective option for the treatment of complicated CD and for the prevention of short bowel syndrome and stoma. PATIENTS AND METHODS: One hundred nineteen patients affected by CD were treated with stricture plasty and mini-resection in our Department between January 1993 and January 1998. At admission, the prior complete clinical and surgical history of each patient was collected and then inserted in a prospectively maintained data base. Analysis of recurrence was made using the Kaplan-Meier function and the influence of certain variables on the risk of recurrence was analyzed using a Cox proportional hazard model. RESULTS: Perioperative mortality was nil, postoperative complications occurred in 8 patients (6.7%). Overall long term surgical recurrence at 5 years was 28%, 35% in patients operated on within one year and 15% in those treated after one year from the diagnosis (p < .05). CONCLUSIONS: Stricture plasty and minimal resections show lower perioperative mortality and postoperative complications similar to resective surgery. From risk factor analysis, a group of patients with high risk of surgical recurrence emerged. In this group and whenever technically possible, we consider stricture plasty and minimal resection the gold standard in the treatment of complicated CD