Number of strictures predictive of recurrent surgical intervention in a paediatric population with obstructive crohn's disease

Abstract

Introduction: Seventy to 90% of Crohn's patients will require surgery, with younger patients often requiring further procedures. Our aim was to investigate whether the number of strictures at time of surgery can predict the need for further surgical intervention. Method: Patients under 20 years undergoing surgery between 1st January 2000 and 1st June 2009 were identified. Data was collected on procedures for stenotic Crohn's disease, including previous surgery outside the original inclusion dates. Therefore operations between 12 December 1996 and 16 February 2009 are represented. Patients were divided into two groups; group 1 with <4 strictures, group 2 with four or more. Recurrence was defined as the need for further surgical intervention and Kaplan Meir method was used for data analysis. Results: Twenty-six patients and 40 operations were identified. Mean age was 15.57 years (7.2-19.4) with equal numbers of males and females. Nineteen operations were strictureplasties, 13 were resections and eight were combined procedures. Mean follow up was 67.44 months (10.5-156.6). 20/ 40 (50%) procedures involved the terminal ileum, 9/40 (22.5%) the ileo-colic junction, 8/40 (20%) the upper GI tract and 3/40 (7.5%) the colon. Group 1 consisted of 29/40 (72.5%) procedures and group 2 11/40 (27.5%). Total recurrence rate was 35% (14/40). Patients in group 1 had significantly less recurrence than group 2 (24% vs 63.6%, P = 0.033). Conclusion: Children and adolescents with four or more strictures at the time of surgery are likely to require further surgical intervention and should be counseled and managed as such.