Pre-operative management is associated with low rate of post-operative morbidity in penetrating Crohn's disease

Philippe Zerbib (1) , Dine Koriche (1) , Stéphanie Truant (1) , Ahmed Fouad Bouras (1) , Gwenola Vernier-Massouille (2) , David Seguy (2) , François-René Pruvot (1) , Antoine Cortot (2) , Jean-Frédéric Colombel (3)

1 Digestive Surgery and Transplantation
2 Hepatogastroenterology
3 Service d'Hépato-gastroentérologie

Background and Aim: Ileocecal resection for penetrating Crohn's disease is still challenging with a high rate of post-operative morbidity and faecal diversion. We report retrospectively the results of pre-operative management for penetrating Crohn's disease focusing on the rate of post-operative major morbidities and need for faecal diversion. Methods: Between 1997 and 2007, 78 patients with penetrating Crohn's disease underwent a first ileocecal resection after a pre-operative management consisting in bowel rest, nutritional therapy, intravenous antibiotics, weaning off steroids and immunosuppressors, and drainage of abscesses when appropriate. Results: Resection was performed for terminal ileitis associated with fistula (n = 41), abscesses (n = 37) or both (n = 5). A pre-operative nutritional therapy was performed in 50 patients (68%) for 23 days (range, 7 - 69 days) along with a weaning off steroids and immunosuppressors. A diverting stoma was performed for 6 patients (7.7%). There was no post-operative death. Post-operative complications were classified as minor in 10 patients (12.8%), and major in 4 patients (5%). Overall, the post-operative course was uneventful in 58 patients (74%). Conclusion: Pre-operative management for penetrating Crohn's disease allowed ileocecal resection with low rate of post-operative morbidity and faecal diversion.

Mots clés: Medicine

Philippe Zerbib, Dine Koriche, Stéphanie Truant, Ahmed Fouad Bouras, Gwenola Vernier-Massouille, et al.. Pre-operative management is associated with low rate of post-operative morbidity in penetrating Crohn's disease. Alimentary Pharmacology and Therapeutics, 2010, 32 (3), pp.459. ⟨10.1111/j.1365-2036.2010.04369.x⟩. ⟨hal-00552578⟩