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Operative Strategy in Recurrent Crohn’s Disease

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Operative Strategies in Inflammatory Bowel Disease
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Abstract

Crohn’s disease is a panenteric chronic inflammatory disease with an inherent tendency to recur after previous medical or surgical therapy. Indeed, two patients described by Crohn and his associates in their original publication had recurrent disease (1). Most of these recurrences are within the 8- to 10-year period after surgery (2–4). The chronicity of the condition, its ability to recur, and its tendency to affect more than one site in the gastrointestinal system suggest that a conservative approach may be preferable whenever surgery is contemplated. Thus, the patient should be fully informed of potential sequelae from surgery, including recurrence, and the decision to operate should include a risk assessment in which the potential disadvantages of surgery outweigh the status quo.

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References

  1. Crohn BB, Ginzburg L, Oppenheimer GD: Regional ileitis: a pathologic and clinical entity. JAMA 1932;99:1323–1329.

    Article  Google Scholar 

  2. Wolff BG, Beart RW Jr, Frydenberg HB, et al. The importance of disease-free margins in resections for Crohn’s disease. Dis Colon Rectum 1983;26:239–243.

    Article  PubMed  CAS  Google Scholar 

  3. Farmer RG, Whelan G, Fazio VW. Long-term follow-up of patients with Crohn’s disease. Relationship between the clinical pattern and prognosis. Gastroenterology 1985;88:1818–1825.

    PubMed  CAS  Google Scholar 

  4. Goligher JC. The long-term results of excisional surgery for primary and recurrent Crohn’s disease of the large intestine. Dis Colon Rectum 1985;28:51–55.

    Article  PubMed  CAS  Google Scholar 

  5. Modigliani R, Mary JY, Simon JF, et al. Clinical, biological, and endoscopic picture of attacks of Crohn’s disease. Evolution on prednisolone. Gastroenterology 1990;98:811–818.

    Article  PubMed  CAS  Google Scholar 

  6. Rutgeerts P, Geboes K, Vantrappen G, et al. Predictability of the postoperative course of Crohn’s disease. Gastroenterology 1990;99:956–963.

    PubMed  CAS  Google Scholar 

  7. Greenstein AJ. The surgery of Crohn’s disease. Surg Clin North Am 1987;67:573–596.

    PubMed  CAS  Google Scholar 

  8. Whelan G, Farmer RG, Fazio VW, et al. Recurrence after surgery in Crohn’s disease. Relationship to location of disease (clinical pattern) and surgical indication. Gastroenterology 1985;88:1826–1833.

    PubMed  CAS  Google Scholar 

  9. Agrez MV, Valente RM, Pierce W, et al. Surgical history of Crohn’s disease in a well-defined population. Mayo Clin Proc 1982;57:747–752.

    PubMed  CAS  Google Scholar 

  10. McLeod RS. Resection margins and recurrent Crohn’s disease. Hepatogastroenterology 1990; 37:63–66.

    PubMed  CAS  Google Scholar 

  11. Kotanagi H, Kramer K, Fazio VW, et al. Do microscopic abnormalities at resection margins correlate with increased anastomotic recurrence in Crohn’s disease? Retrospective analysis of 100 cases. Dis Colon Rectum 1991;34:909–916.

    Article  PubMed  CAS  Google Scholar 

  12. Fazio VW, Tjandra JJ, Lavery IC, et al. Long-term follow-up of strictureplasty in Crohn’s disease. Dis Colon Rectum 1993;36:355–361.

    Article  PubMed  CAS  Google Scholar 

  13. Andrews HA, Keighley MR, Alexander-Williams J, et al. Strategy for management of distal ileal Crohn’s disease. Br J Surg 1991;78:679–682.

    Article  PubMed  CAS  Google Scholar 

  14. Hellers G. Crohn’s disease in Stockholm county 1955–1974. A study of epidemiology, results of surgical treatment and long-term prognosis. Acta Chir Scand Suppl 1979;490:1–84.

    PubMed  CAS  Google Scholar 

  15. McNamara MJ, Fazio VW, Lavery IC, et al. Surgical treatment of enterovesical fistulas in Crohn’s disease. Dis Colon Rectum 1990;33:271–276.

    Article  PubMed  CAS  Google Scholar 

  16. Greenstein AJ, Lachman P, Sachar DB, et al. Perforating and nonperforating indications for repeated operations in Crohn’s disease: evidence for two clinical forms. Gut 1988;29:588–592.

    Article  PubMed  CAS  Google Scholar 

  17. McDonald PJ, Fazio VW, Farmer RG, et al. Perforating and nonperforating Crohn’s disease. An unpredictable guide to recurrence after surgery. Dis Colon Rectum 1989;32:117–120.

    Article  PubMed  CAS  Google Scholar 

  18. Aeberhard P, Berchtold W, Riedtmann HJ, et al. Surgical recurrence of perforating and nonperforating Crohn’s disease. A study of 101 surgically treated patients. Dis Colon Rectum 1996;39:80–87.

    Article  PubMed  CAS  Google Scholar 

  19. Schoetz DJ Jr. Gastroduodenal Crohn’s disease. Perspect Colon Rectal Surg 1992;2:145–154.

    Google Scholar 

  20. Murray JJ, Schoetz DJ Jr, Nugent FW, et al. Surgical management of Crohn’s disease involving the duodenum. Am J Surg 1984;147:58–65.

    Article  PubMed  CAS  Google Scholar 

  21. Broe PJ, Bayless TM, Cameron JL. Crohn’s disease: Are enteroenteral fistulas an indication for surgery? Surgery 1982;91:249–253.

    PubMed  CAS  Google Scholar 

  22. Dominguez JM, Frizelle FA, Wolff BG. Duodenal fistulas in Crohn’s disease (abstract). Dis Colon Rectum 1996;39:A36.

    Article  Google Scholar 

  23. Williams AJ, Palmer KR. Endoscopic balloon dilatation as a therapeutic option in the management of intestinal strictures resulting from Crohn’s disease. Br J Surg 1991;78:453–454.

    Article  PubMed  CAS  Google Scholar 

  24. Alexander-Williams J, Haynes IG. Conservative operations for Crohn’s disease of the small bowel. World J Surg 1985;9:945–951.

    Article  PubMed  CAS  Google Scholar 

  25. Spencer MP, Nelson H, Wolff BG, et al. Strict-ureplasty for obstructive Crohn’s disease: the Mayo experience. Mayo Clin Proc 1994;69:33–36.

    Article  PubMed  CAS  Google Scholar 

  26. Young-Fadok TM, Wolff BG, Meagher A, et al. Surgical management of ileosigmoid fistula in Crohn’s disease (abstract). Dis Colon Rectum 1996;39:A38.

    Google Scholar 

  27. Hawker PC, Gyde SN, Thompson H, et al. Adenocar-cinoma of the small intestine complicating Crohn’s disease. Gut 1982;23:188–193.

    Article  PubMed  CAS  Google Scholar 

  28. Longo WE, Ballantyne GH, Cahow CE. Treatment of Crohn’s colitis. Segmental or total colectomy? Arch Surg 1988;123:588–590.

    Article  PubMed  CAS  Google Scholar 

  29. Prabhakar LP, Laramee C, Nelson H, et al. Avoiding a stoma: the role for segmental colectomy in Crohn’s colitis (abstract). Dis Colon Rectum 1996;39:A23.

    Article  Google Scholar 

  30. Ekbom A, Helmick C, Zack M, et al. Increased risk of large-bowel cancer in Crohn’s disease with colonic involvement. Lancet 1990;336:357–359.

    Article  PubMed  CAS  Google Scholar 

  31. Yamazaki Y, Ribeiro MB, Sachar DB, et al. Malignant colorectal strictures in Crohn’s disease. Am J Gastroenterol 1991;86:882–885.

    PubMed  CAS  Google Scholar 

  32. Trnka YM, Glotzer DJ, Kasdon EJ, et al. The long-term outcome of restorative operation in Crohn’s disease: influence of location, prognostic factors and surgical guidelines. Ann Surg 1982;196:345–355.

    Article  PubMed  CAS  Google Scholar 

  33. Breysem Y, Janssens JF, Coremans G, et al. Endoscopie balloon dilation of colonie and ileocolonic Crohn’s strictures: long-term results. Gastrointest Endosc 1992;38:142–147.

    Article  PubMed  CAS  Google Scholar 

  34. Sharif H, Alexander-Williams J. Strictureplasty for ileocolic anastomotic strictures in Crohn’s disease. Int J Colorectal Dis 1991;6:214–216.

    Article  PubMed  CAS  Google Scholar 

  35. Williams DR, Coller JA, Corman ML, et al. Anal complications in Crohn’s disease. Dis Colon Rectum 1981;24:22–24.

    Article  PubMed  CAS  Google Scholar 

  36. White RA, Eisenstat TE, Rubin RJ, et al. Seton management of complex anorectal fistulas in patients with Crohn’s disease. Dis Colon Rectum 1990;33:587–589.

    Article  PubMed  CAS  Google Scholar 

  37. Bayer I, Gordon PH. Selected operative management of fistula-in-ano in Crohn’s disease. Dis Colon Rectum 1994;37:760–765.

    Article  PubMed  CAS  Google Scholar 

  38. Sagar PM, Dozois RR, Wolff BG. Long-term results of ileal pouch-anal anastomosis in patients with Crohn’s disease. Dis Colon Rectum 1996;39:893–898.

    Article  PubMed  CAS  Google Scholar 

  39. McLeod RS, Wolff BG, Steinhart AH, et al. Prophylactic mesalamine treatment decreases postoperative recurrence of Crohn’s disease. Gastroenterology 1995;109:404–413.

    Article  PubMed  CAS  Google Scholar 

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© 1999 Springer Science+Business Media New York

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Farouk, R., Dozois, R.R. (1999). Operative Strategy in Recurrent Crohn’s Disease. In: Michelassi, F., Milsom, J.W. (eds) Operative Strategies in Inflammatory Bowel Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1396-3_34

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  • DOI: https://doi.org/10.1007/978-1-4612-1396-3_34

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7130-7

  • Online ISBN: 978-1-4612-1396-3

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