Study On The Influencing Factors Of Reoperation After Crohn's Disease

Frequency and Risk Factors of Surgical Recurrence of Crohn's Disease After Primary Bowel ResectionObjective:The purpose of this study was to evaluate the frequency and risk factors associated with Crohn's disease reoperation after first bowel resection.Methods : We identified 166 Crohn's disease patients with first time bowel resection and primary anastomosis from the clinical database of the Affiliated Nanjing General Hospital of Nanjing Medical University.We retrospectively analyzed the outpatient and hospital records of all patients through letters,scheduled medical exam,and telephone interviews.Gender,duration of disease,prior surgery history,smoking history,extra-intestinal manifestations,surgical approach,age at diagnosis,location of disease,behavior of disease and the postoperative maintenance treatment were assessed to figure out risk factors for reoperation by univariate and then multivariate analysis.Results : The median age of reoperation was 30 years old and the median RFS was 30 months.The reoperation intervention rate was 16.9%.It was shown that smoking(P =0.015)and jejunoileal anastomosis(P =0.002)were significantly closely correlated to increased risks of surgical recurrence,whereas laparoscopy(P =0.039),side-to-side anastomosis(P=0.018),and anastomotic stoma wider than 3 cm(P =0.024)were significantly closely correlated to reduced risks of surgical recurrence.Conclusion:This study provided a robust result that smoking and small intestinal lesions were the risk factors of surgical recurrence for Crohn's disease patients upon initial gut resection.Laparoscopy,side-to-side anastomosis,and wide anastomotic stoma were found to be protective factors against surgical recurrence.Non-penetrating Residual Lesions do not Increase the Risk of Reoperation in Patients with Crohn's DiseaseObjective:The aim of this study was to investigate the impact of non-penetrating residual lesions on the risk of reoperation in patients with CD who underwent primary bowel resection.Methods:This was a retrospective study of 148 patients with CD who were hospitalized in Jinling Hospital Affiliated to Nanjing Medical University between January 1,2008,and October 1,2016.Gender,duration of disease,prior surgery history,smoking history,extra-intestinal manifestations,surgical approach,age at diagnosis,location of disease,behavior of disease,residual lesions,postoperative complications,postoperative observation indexes,and the postoperative maintenance treatment were assessed to figure out risk factors for reoperation by univariate and then multivariate analysis.Results:One hundred and fourty-eight patients were analyzed.Smoking(HR 7.542;95% CIs,1.838-30.953;p = 0.005),and Clavien-Dindo classification ? complications(HR 15.315;95% CIs,3.054-76.797;p = 0.001)were significantly correlated to increased risks of reoperation,whereas the risk of second abdominal surgery in A2(age between 17 and 40)(HR 0.105;95% CIs,0.025-0.45;p = 0.002)and A3(age > 40)(HR 0.038;95% CIs,0.004-0.388;p = 0.006)were obviously lower than A1(age ? 16).There was no relationship between non-penetrating residual lesions and reoperation in CD.Conclusion:It is critical for CD patients to receive appropriate surgical management.In our opinion,smoking history,postoperative complications,and age at onset under 17 years old were correlated to increased risks of reoperation.Preserving non-penetrating residual lesions was not associated with worseoutcomes compared to those without residual lesions.No Association between staging operation and the 5-Year Risk of Reoperation in Patients with Crohn's DiseaseObjective:investigate the impact of staging operation on the risk of reoperation in patients with CD who underwent primary bowel resection.Methods:This was a retrospective study of 979 patients with CD who were hospitalized in Jinling Hospital Affiliated to Nanjing Medical University between January 1,2001,and October 1,2016.The patients were grouped according to staging operation(n=64)and one-stage operation(n=148).Postoperative intestinal function recovery time,postoperative short-term complications,and reoperation rates were compared between the two groups.Results:There was significant difference in disease behavior between the staging operation group and the one-stage operation group.There was no significant difference in postoperative tolerance of enteral nutrition among groups(P>0.05).Obvious differences were found in the comparison of the first time of exhaustion,defecation after operation,postoperative length of stay and postoperative complications among groups(all P<0.05).There was no difference in the 5-year cumulative reoperation-free rates between the two groups(P>0.05).Conclusion:In conclusion,surgical intervention at proper time and appropriate operation during operation are essential for patients with CD.It is believed that staging operation with ostomy followed by intestinal anastomosis is feasible when there are more than two risk factors for postoperative intra-abdominal infectious complications.