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 25 May 2018

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News

Surgery outcomes for perforating vs nonperforating Crohn's

The latest American Journal of Gastroenterology compares the incidence of recurrence and reoperation after surgery for perforating vs nonperforating Crohn's.

News image

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Dr Constantinos Simillis and colleagues from the United Kingdom used meta-analytical techniques to compare the incidence of recurrence and the indication for reoperation in patients with Crohn's disease.

The team compared patients who underwent their first operation, due to perforating disease with patients who underwent their first operation due to nonperforating disease.

The team identified comparative studies published between 1988 and 2005 of perforating versus nonperforating Crohn's disease.

44% had perforating indications and 56% had nonperforating indications for surgery
The American Journal of Gastroenterology

The team's end points included recurrence of Crohn's disease given as reoperation, and the indication for reoperation.

Heterogeneity was assessed and a sensitivity analysis was performed to account for bias in patient selection.

The researchers found 13 studies that reported on 3,044 patients.

Of these patients, 44% had perforating indications and 56% had nonperforating indications for surgery.

The recurrence was found to be significantly higher in the perforating group compared to the non-perforating group.

The research team found significant heterogeneity among studies.

The team found the recurrence remained higher in the perforating group compared with the non-perforating group during sensitivity analysis of high-quality studies and more recent studies.

At reoperation, concordance was found in the disease type of those patients re-presenting with perforating disease, without heterogeneity among studies.

The team found concordance at reoperation in those with nonperforating disease, with significant heterogeneity among studies.

The team observed that concordance in disease type remained when considering only high-quality studies, and more recent studies.

Dr Similes' team concluded, "The indication for reoperation in Crohn's disease tends to be the same as the primary operation."

"Perforating disease tends to re-present as perforating disease, and nonperforating as nonperforating."

"Also, perforating Crohn's disease appears to be associated with a higher recurrence rate compared with nonperforating Crohn's disease."

"However, because of significant heterogeneity among studies, further studies should be undertaken to confirm this finding."

Am J Gastroenterol 2008: 103(1): 196-205
17 January 2008

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