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The Role of Primary Surgical Procedure in Maintaining Intestinal Continuity for Patients With Crohn's Colitis

Kiran, Ravi P. MBBS, FRCS; Nisar, Pasha J. DM, FRCS; Church, James M. MBChB, FRACS; Fazio, Victor W. MB, MS, FRACS

doi: 10.1097/SLA.0b013e318212b1a4
Original Articles

Objective: This study evaluates surgical procedures for Crohn's colitis. The risk of recurrence and how it interacts with future avoidance of permanent stoma and quality of life (QoL) is studied.

Background: Segmental and subtotal colectomy are widely used surgical options in isolated Crohn's colitis. It is not clear which procedure offers the best outcomes.

Methods: Patients undergoing index resection for isolated colonic Crohn's disease (CD) from 1995 to 2009, were identified from a prospectively maintained CD database. Patients were categorized into subtotal colectomy or segmental groups. Demographics, disease characteristics, operative details, morbidity, stoma formation, recurrence requiring surgery and QoL data were extracted. Recurrence and stoma free survival was calculated for each group and independent risk factors for recurrence and stoma formation identified.

Results: One hundred and eight patients (49 segmental, 59 subtotal) underwent primary colectomy with anastomosis. Segmental colectomy patients had significantly reduced recurrence free survival (P = 0.032) but not stoma free survival P = 0.62 on univariate analysis. On multivariate analysis, the presence of perianal sepsis (P = 0.032) and >1 medical comorbidity (P = 0.01), but not segmental colectomy, were associated with reduced SFS. There was no difference in Cleveland Global Quality of Life (P = 0.88), or Short Form Inflammatory Bowel Disease Questionnaire scores between groups (P = 0.92).

Conclusions: Using a strictly defined cohort of patients, we were unable to identify segmental resection as an independent risk factor for recurrence or stoma formation and no reduction in QoL scores to suggest an adverse effect of recurrence was observed. Segmental colectomy affords good function, and our data supports the practice of a conservative approach with anastomosis in anatomically linked CD.

In patients undergoing segmental versus subtotal resection for Crohn's colitis, no difference was observed in stoma free survival or quality of life. Segmental colectomy patients experienced shorter recurrence-free survival on univariate but not multivariate analysis. Segmental colectomy is the procedure of choice in isolated Crohn's colitis.

From the Department of Colorectal Surgery Cleveland Clinic Foundation, Cleveland, OH.

Reprints: Ravi P. Kiran, MBBS, FRCS, Staff Surgeon and Head of Research, Department of Colorectal Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail:

The authors declare no conflict of interest.

© 2011 Lippincott Williams & Wilkins, Inc.