Resección ileocecal por enfermedad de Crohn: Resultados y seguimiento

Abstract

Background: Approximately 50% of patients with Crohn's disease (CD) will need a surgical treatment in the long term course of the disease. The ileocaecal resection (ICR) is the most common operations in patients with CD. Aim: To identify the surgical indications and to determine the rate of recurrence in late follow up of the patients who underwent ICR for CD. Material and method: Consecutive inclusion of patients submitted to ICR between 1970 and 2006. Demographic characteristics, surgical indications, intraoperative findings, postoperative complications and recurrence of the disease were analyzed. Results: 28 patients had an ICR in this period. Average age at diagnosis of CD 34.8 years (r: 14-60), ICR 43.3 years (r: 16-68). 60.7% female gender. Six patients were previously operated for CD (3 over perine and 3 partial resection of small bowel, no ICR). One or more of the following clinical conditions were considered surgical indications: Intermittent intestinal obstruction in 21 patients, failure of medical treatment in 10, enteral fistulae 2 and lower intestinal bleeding 2. Nine patients (32.1%) had one or more postoperative complications. 3 (10%) of them were re-operated (2 for leakage and fistulae, one for hemoperitoneum). The median postoperative stay was 9 days. There was no postoperative mortality (30 days). In the long term follow up, 3 (10%) patients developed intestinal obstruction due to adhesions. All of them needed an operation. Four patients (14%) were reoperated for CD with a mean time of 63 months since the ICR. Two of them for stenosis of ileocolic anastomosis and two for perianal abscess and fistulae. The 5 year survival was 96%. Conclusion: Stenosis and intestinal obstruction of the terminal ileum is the main indication for ICR.