Introduction Up to 70% of patients with Crohn’s disease (CD) may require surgery at some point in their lives and 39% may require several surgeries. Repeated resections put patients at risk of greater morbidity including short gut syndrome and intestinal failure.
Method We aimed to examine the demographic and clinical characteristics and outcomes of patients requiring repeated resections for CD. We performed a retrospective analysis by interrogating the pathology database over a five year period from 2009 to 2013 to identify cases and data was extracted by chart review.
Results Of 152 cases in the time frame, 54 were having repeat intestinal resections undertaken. Median age was 43 years (range 20 to 75). 59.3% were female. The median duration between resections in this group was 9 years (range 1 to 49). 29.6% were emergency procedures. 41 patients had 1 previous resection, 9 had 2 previous surgeries with 4 having had 3 or more prior resections. The most common procedures were re-do right hemicolectomy accounting for 38.9% of procedures. 13.0% of patients had repeat small bowel resections. 14.8% had right hemicolectomy after previous small bowel resection. 14.8% had small bowel resection after previous partial or total colectomy. 11.1% patients had completion colectomy. 25.9% of patients had no prophylactic therapy against CD since the previous resection. Median duration to repeat resection in this group was 15 years. 35 patients had received azathioprine with a median duration to resection of 8 years, 20 patients had been on anti-tnf with median duration to resection of 8.5 years and 11 had methotrexate with median duration to resection of 7 years. Median duration of follow-up was 30 months (range 3 to 69). At end of follow up 66.6% of patients remained steroid and repeat resection free. 11.1% had required corticosteroids, 7.4% had gone on to have a further resection within the period of follow up and 5.6% of patients had died. In the same follow up period only 1 death was noted in the group who had their first resection (1%). 4 were lost to follow up (mean duration 17.5 months).
Conclusion Repeat resections are common undertakings in patients with postoperative CD. The proportion of these cases being done as emergencies is similar to those in the surgery naïve cohort. The most common procedure is redo right hemicolectomy and resection of anastomosis. Duration to repeat resection is considerably longer in those who don’t receive medical prophylaxis against CD, indicating a prolonged silent, indolent disease course in a particular subgroup. Among patients who receive prophylaxis, patients with anti-TNF have a longer median duration to repeat resection compared to those on immunomodulators.
Disclosure of interest None Declared.