Surgical Outcome of Inflammatory Bowel Disease - Experience of a Tertiary Center
R. Zaharie, F. Zaharie, L. Mocan, V. Andreica, M. Tantau, C. Zdrehus, C. Iancu, C. TomusOriginal article, no. 6, 2013
Backgrounds Aim: Despite advances in medical treatment, alarge number of patients with inflammatory bowel disease(IBD) require surgery. We aim to evaluate the efficacy andoutcome of surgical interventions in patients with chronicinflammatory bowel diseases.Material and Methods: We retrospectively analysed themedical records from 221 patients admitted to our institutionbetween 2009-2012 with the diagnosis of IBD. Out of thesepatients, 55 (24.88 %) were diagnosed with Crohn’s disease,while the remaining 166 patients (75.11%) had ulcerative colitis.Results: Seventeen of 55 patients with Crohn’s disease (30.91%)required surgical management before or during this period. Ninewith disease proximal to the transverse colon underwentsegmental resections (enteral or colonic) with primaryanastomosis, without morbidity. The other 8 patients, withdisease distal to the transverse colon, underwent segmentalcolonic resections (two with primary anastomosis, three withstoma formation) or major colonic resection- subtotal colectomywith ileostomy (1 case) and total proctocolectomy with ileostomy(2 cases). Sixteen of 166 patients with ulcerative colitis(9.64%) required surgery before or during this period. Thesurgical procedure used included total proctocolectomy withdefinitive ileostomy (3 cases) and total colectomy with ileostomy(13 cases). 7 of the 13 patients had restorative surgery after totalcolectomy, 1 remaining with definitive ileostomy due to shortvascular pedicle and 5 patients refused restorative surgery.Median daily stool frequency after reconstructive surgery was 7(range 3â€"12).Conclusion: For patients with Crohn’s disease proximal to thetransverse colon, limited resection with primary anastomosis issafe. Major colonic resection (subtotal colectomy or proctocolectomy)is indicated if the disease is located distal to thetransverse colon and primary anastomosis should be avoided.Due to unsatisfactory quality of live after reconstructive surgery(stool frequency remains high), total proctocolectomy withend-ileostomy remains a viable alternative for patients withulcerative colitis.
