대한대장항문학회

Purpose: We sought to determine the long-term outcome of surgical management for gastrointestinal Crohns’s disease (CD) and to find out whether there is any improvement over the time period. Methods: We analyzed the records of the 102 patients who underwent surgery for gastrointestinal CD excluding perianal CDbetween 1978 and 2007. A cumulative surgical recurrence rate was analyzed by Kaplan-Meier plots and log-rank tests. Results: The main sites of CD were ileocecal area in 54.5%, followed by small bowel (29.7%) and large bowel (7.9%). Common indications for operation were obstruction (25.7%), diagnostic purpose (20.8%), and failure of medical treatment (12.9%). The operation performed were ileocolectomy including right hemicolectomy in 53 cases (45.3%), small bowel resection in 38 cases (31.7%), and strictureplasty 12 cases (10.0%, including 11 cases combined with bowel resection). The average follow-up period after operation was 6.4years (range: 0.5∼29 yr, median: 5.3 yr). Among all patients, 22 (21.6%) underwent operations for recurrence. The re-operation rate was higher in the younger patients group (age at diagnosis less than 25 years) (34.1% vs. 12.1%, P＜0.05), and in case of the patients whose length of initial intestinal resection was less than 40 cm (27.9% vs. 7.7%, P＜0.05). The overall cumulative re-operation rates at 5years, 10years and 15years were 15%, 25%, and 60%, respectively. Conclusions: Despite recent advances in medical therapy, the cumulative re-operation rate of patients operated for gastrointestinal CD remains similar to our previous report in 1997.