Dr Michael Siassi and colleagues from Germany analyzed changes in surgery for Crohn's disease in a single institution over a period of 33 years.
The data of all patients undergoing abdominal surgery for Crohn's disease between 1970 and 2002 were collected prospectively in an electronic database.
The investigative team divided the study period into 3 periods of 11 years each.
Group 1 included the study period from 1970 to 1980.
Group 2 covered the years from 1981 to 1991.
|Elective surgery increased from 70% in Group 1 to 81% in Group 2|
|International Journal of Colorectal Diseases|
The study period from 1992 and 2002 was allocated to Group 3.
The investigators observed an increase in patients' age at time of hospital admission from 32 to 33 and 38 years, with disease durations of 5, 7 and 9 years.
The team noted an increase in the number of drug-induced remissions before surgery.
The number of drug-induced remissions increased from 3 to 6 and 5 in Groups 1, 2, and 3, respectively.
The rates of elective surgery compared to urgent or emergency surgery increased from 70% in Group 1 to 81% in Groups 2 and 3.
The investigators observed a significant decrease in hospital mortality.
The analysis of Crohn's complications demanding surgery revealed a significant increase of rates of stenosis and subileus.
In addition, the team found a significant increase in serious acute complications like free bowel perforations and peritonitis.
Dr Siassi's team comments, “Improved medical treatment may lead to higher rates of elective operations.”
“However, prolonged conservative treatment may also increase the number of serious complications before surgery.”
“Therefore, a multidisciplinary approach with early involvement of the surgeon is important to avoid any delay in indication to surgery.”