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Author(s): A. Anou, H. Bendib, N. Smail.

Volume/Issue: Volume 6 , Issue 1 (2023)

Abstract:

Introduction: Despite the progress made in the medical management of Crohn's disease (CD), a vast number of patients are operated on at least once in their lifetime. Although this is a mild disease that occurs mainly in young patients with little comorbidity, CD surgery is accompanied by significant postoperative morbidity (PO). This study aims to analyse the PO complications of the small intestine's CD and look for the risk factors for its occurrence. Patients and methods: this is a single-centre prospective study that collected 83 files of patients operated on for CD of the small intestine for 28 months (May 2017 - September 2019). All patients had histologic confirmation of CD. Isolated anoperineal and colorectal forms were excluded from this work. PO morbidity is defined by all complications occurring during the first 30 days of PO. A statistical analysis of PO morbidity was performed as a function of 12 parameters: age; sex; comorbidity; history of abdominal surgery; history of surgery for CD; haemoglobin level (Hb at 10 mg/dl); albumin level ( at 34g / l); BMI ( at 19); ASA score; mode of surgery (cold vs emergency); intra-abdominal abscess; operative procedure (resection-anastomosis vs resection-stoma). Statistical analysis was performed first univariate and then multivariate (SPSS 16 software). Results: These were 56 women and 27 men, with a sex ratio of 2. The mean age of the patients was 35 years (13-65). The overall PO morbidity rate was 26%; this morbidity was surgical in 86%, septic in 89.5% and intra-abdominal septic in 50% of cases. Complications were major (CMPO) in 39.5% of cases. The mode of emergency surgery was an independent risk factor for the occurrence of complications (p = 0.005). Conclusion: Small intestine CD surgery is associated with very high PO morbidity. The mode of emergency surgery is an independent risk factor for the onset of PO complications. Patients who require surgery should be operated on as elective or scheduled surgery. The indications for emergency surgery for CD are sporadic.

Keywords:

Crohn's, surgery, morbidity, complications, emergency

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