[Comparison between staged surgery and one-stage surgery in active complex Crohn disease].

OBJECTIVE

To compare the prognosis between staged surgery and one-stage surgery in active complex Crohn disease(CD).

METHODS

Clinical data of 33 patients with active complex CD from February 2006 to September 2010 were analyzed retrospectively.

INCLUSION CRITERIA

Patients who were diagnosed with CD by pathology or endoscopy with CD activity index(CDAI)>220 and long history of preoperative steroid use(over 6 months), or complicated with severe preoperative malnutrition. The indications for surgery included enterocutaneous or entero enteric fistula, with/without intra-abdominal abscess, intestinal obstruction, and acute intestinal perforation intra-abdominal sepsis. The surgical procedures, including staged surgery and one-stage definite surgery were chosen by experienced surgeons. All the patients quit smoking and received immunosuppressant therapy (TwHF or azathioprine) together with enteral nutrition supplement for preventing postoperative recurrence. All the patients were followed up after the surgery with regards to CDAI, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR). Postoperative complications, clinical and endoscopic recurrence were recorded.

RESULTS

Of the 33 patients, 14 underwent one-stage definite surgery and 19 received staged surgery. Postoperative complication rates in the two groups were 71% and 26% respectively(P=0.015). The early clinical recurrence rates within postoperative 3 months were 36% and 0(P=0.008). In regard to cumulative probability of post-operative clinical and endoscopic recurrence, staged surgery group was superior to one stage definite surgery group(P=0.000 and 0.006).

CONCLUSION

Staged surgery may significantly increase the success rate of operation, reduce postoperative complications and postoperative early relapse, and decrease postoperative recurrence.