Pre‐operative management is associated with low rate of post‐operative morbidity in penetrating Crohn’s disease

• Published in: Alimentary pharmacology & therapeutics Vol. 32; no. 3; pp. 459 - 465
• Main Authors: Zerbib, P., Koriche, D., Truant, S., Bouras, A. F., Vernier‐Massouille, G., Seguy, D., Pruvot, F. R., Cortot, A., Colombel, J. F.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2010; Blackwell; Wiley
• Subjects: Abscess - surgery; Adolescent; Adult; Aged; Antibiotic Prophylaxis; Biological and medical sciences; Crohn Disease - surgery; Digestive system; Enteral Nutrition; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Pharmacology. Drug treatments; Postoperative Complications - surgery; Preoperative Care - adverse effects; Retrospective Studies; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Young Adult; Postoperative; Crohn disease; Clinical management; Digestive diseases; Intestinal disease; Morbidity; Inflammatory disease; Medicine
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2010.04369.x

Aliment Pharmacol Ther 2010; 32: 459–465 Summary Background  Ileocaecal resection for penetrating Crohn’s disease is still challenging with a high rate of post‐operative morbidity and faecal diversion. Aim  To report retrospectively the results of pre‐operative management for penetrating Crohn’s disease focusing on the rate of post‐operative major morbidities and need for faecal diversion. Methods  Between 1997 and 2007, 78 patients with penetrating Crohn’s disease underwent a first ileocaecal resection after a pre‐operative management consisting in bowel rest, nutritional therapy, intravenous antibiotics, weaning off steroids and immunosuppressors, and drainage of abscesses when appropriate. Results  Resection was performed for terminal ileitis associated with (n = 41), abscesses (n = 37) or both (n = 5). A pre‐operative nutritional therapy was performed in 50 patients (68%) for 23 days (range, 7–69 days) along with a weaning off steroids and immunosuppressors. A diverting stoma was performed for six patients (7.7%). There was no post‐operative death. Post‐operative complications were classified as minor in 10 patients (12.8%), and major in four patients (5%). Overall, the post‐operative course was uneventful in 58 patients (74%). Conclusion  Pre‐operative management for penetrating Crohn’s disease allowed ileocaecal resection with low rates of post‐operative morbidity and faecal diversion.