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Vol. 72, No. 4, 2005
Issue release date: 2005

Risk Factors Regarding the Need for a Second Operation in Patients with Crohn’s Disease

Avidan B. · Sakhnini E. · Lahat A. · Lang A. · Koler M. · Zmora O. · Bar-Meir S. · Chowers Y.
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Background/Aims: The majority of Crohn’s disease patients undergo surgery. However, the factors that predict post-operative recurrence remain controversial. The aim of the present study was to shed light on the potential predictors of such recurrence. Methods: 86 patients who underwent operative procedures for Crohn’s disease were retrospectively studied. Recurrence was defined as the need for a second operation. Life table and multivariate analysis were performed to find the predictors of recurrence. Results: In 26/86 (30%) of the patients, post-operative recurrence was diagnosed within a mean of 42 months of the follow-up. Logistic regression analysis revealed that smoking (OR 3.69, 95% CI 2.06–11.52) and perforating disease (OR 4.09, 95% CI 1.31–12.65) were associated with a risk of recurrence. However, survival analysis showed that only perforating disease was associated with an early post-operative recurrence (log-rank test, p < 0.001). Neither resected surgical specimen characteristics, nor the duration and the location of the disease were found to predict the need for a second operation. Conclusion: The risk for Crohn’s disease patients who undergo surgery is related to the presence of perforating disease and smoking, which predict the need for a second operation. The former is associated with an even earlier recurrence.

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  1. Sachar DB: The problem of postoperative recurrence of Crohn’s disease. Med Clin North Am 1990;74:183–188.
  2. Whelan G, Farmer RG, Fazio VW, Goormastic M: Recurrence after surgery in Crohn’s disease. Relationship to location of disease (clinical pattern) and surgical indication. Gastroenterology 1985;88:1826–1833.
  3. De Dombal FT, Burton I, Goligher JC: Recurrence of Crohn’s disease after primary excisional surgery. Gut 1971;12:519–527.
  4. Greenstein AJ, Lachman P, Sachar DB, Springhorn J, Heimann T, Janowitz HD, Aufses AH Jr: Perforating and non-perforating indications for repeated operations in Crohn’s disease: evidence for two clinical forms. Gut 1988;29:588–592.
  5. McDonald PJ, Fazio VW, Farmer RG, Jagelman DG, Lavery IC, Ruderman WB, Easley KA, Harper PH: Perforating and nonperforating Crohn’s disease. An unpredictable guide to recurrence after surgery. Dis Colon Rectum 1989;32:117–120.
  6. Aeberhard P, Berchtold W, Riedtmann HJ, Stadelmann G: Surgical recurrence of perforating and nonperforating Crohn’s disease. A study of 101 surgically treated patients. Dis Colon Rectum 1996;39:80–87.
  7. Sachar DB, Subramani K, Mauer K, Rivera-MacMurray S, Turtel P, Bodian CA, Greenstein AJ: Patterns of postoperative recurrence in fistulizing and stenotic Crohn’s disease. A retrospective cohort study of 71 patients. J Clin Gastroenterol 1996;22:114–116.
  8. Trnka YM, Glotzer DJ, Kasdon EJ, Goldman H, Steer ML, Goldman LD: 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.
  9. Heimann TM, Greenstein AJ, Lewis B, Kaufman D, Heimann DM, Aufses AH Jr: Prediction of early symptomatic recurrence after intestinal resection in Crohn’s disease. Ann Surg 1993;218:294–299.
  10. Poggioli G, Laureti S, Selleri S, Brignola C, Grazi GL, Stocchi L, Marra C, Magalotti C, Grigioni WF, Cavallari A: Factors affecting recurrence in Crohn’s disease. Results of a prospective audit. Int J Colorectal Dis 1996;11:294–298.
  11. Lautenbach E, Berlin JA, Lichtenstein GR: Risk factors for early postoperative recurrence of Crohn’s disease. Gastroenterology 1998;115:259–267.
  12. Baldassano RN, Han PD, Jeshion WC, Berlin JA, Piccoli DA, Lautenbach E, Mick R, Lichtenstein GR: Pediatric Crohn’s disease: risk factors for postoperative recurrence. Am J Gastroenterol 2001;96:2169–2176.
  13. McLeod RS, Wolff BG, Steinhart AH, Carryer PW, O’Rourke K, Andrews DF, Blair JE, Cangemi JR, Cohen Z, Cullen JB, Chaytor RG, Greenberg GR, Jaffer NM, Jeejeebhoy KN, MacCarty RL, Ready RL, Weiland LH: Risk and significance of endoscopic/radiological evidence of recurrent Crohn’s disease. Gastroenterology 1997;113:1823–1827.
  14. Rutgeerts P, Geboes K, Vantrappen G, Kerremans R, Coenegrachts JL, Coremans G: Natural history of recurrent Crohn’s disease at the ileocolonic anastomosis after curative surgery. Gut 1984;25:665–672.
  15. D’Haens G: Prevention of postoperative recurrence in Crohn’s disease. Curr Gastroenterol Rep 1999;1:476–481.
  16. Bernell O, Lapidus A, Hellers G: Risk factors for surgery and postoperative recurrence in Crohn’s disease. Ann Surg 2000;231:38–45.
  17. Gilberts EC, Greenstein AJ, Katsel P, Harpaz N, Greenstein RJ: Molecular evidence for two forms of Crohn disease. Proc Natl Acad Sci USA 1994;91:12721–12724.
  18. Nemetz A, Nosti-Escanilla MP, Molnar T, Kope A, Kovacs A, Feher J, Tulassay Z, Nagy F, Garcia-Gonzalez MA, Pena AS: IL-1B gene polymorphisms influence the course and severity of inflammatory bowel disease. Immunogenetics 1999;49:527–531.
  19. Cottone M, Rosselli M, Orlando A, Oliva L, Puleo A, Cappello M, Traina M, Tonelli F, Pagliaro L: Smoking habits and recurrence in Crohn’s disease. Gastroenterology 1994;106:643–648.
  20. Sutherland LR, Ramcharan S, Bryant H, Fick G: Effect of cigarette smoking on recurrence of Crohn’s disease. Gastroenterology 1990;98:1123–1128.
  21. Griffiths AM, Wesson DE, Shandling B, Corey M, Sherman PM: Factors influencing postoperative recurrence of Crohn’s disease in childhood. Gut 1991;32:491–495.
  22. Hamilton SR, Reese J, Pennington L, Boitnott JK, Bayless TM, Cameron JL: The role of resection margin frozen section in the surgical management of Crohn’s disease. Surg Gynecol Obstet 1985;160:57–62.
  23. Wolfson DM, Sachar DB, Cohen A, Goldberg J, Styczynski R, Greenstein AJ, Gelernt IM, Janowitz HD: Granulomas do not affect postoperative recurrence rates in Crohn’s disease. Gastroenterology 1982;83:405–409.
  24. Hamilton SR: Pathologic features of Crohn’s disease associated with recrudescence after resection. Pathol Annu 1983;18:191–203.
  25. Heuman R, Boeryd B, Bolin T, Sjodahl R: The influence of disease at the margin of resection on the outcome of Crohn’s disease. Br J Surg 1983;70:519–521.
  26. Nygaard K, Fausa O: Crohn’s disease. Recurrence after surgical treatment. Scand J Gastroenterol 1977;12:577–584.
  27. Pennington L, Hamilton SR, Bayless TM, Cameron JL: Surgical management of Crohn’s disease. Influence of disease at margin of resection. Ann Surg 1980;192:311–318.

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