Ileocolic resection: a safe and durable option for limited Crohn’s disease of the terminal
ileum
E.J. Eshuis1,2, A. Kraima1, C.P. Ponsioen2, P.C.F. Stokkers2,3, W.A. Bemelman1
1
Department of Surgery, Academic Medical Center, Amsterdam.
2
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam.
3
Department of Gastroenterology and Hepatology, St Lucas Andreas Hospital, Amsterdam.
Aim of the present study was to assess the long-term results in patients who underwent an
ileocolic resection for Crohn’s disease.
All patients who underwent primary ileocolic resection for Crohn’s disease within the period
1998-2009 were included. Endpoints were postoperative complication rates, the clinical and
surgical recurrences and time to re-resection. Clinical recurrence was defined as any intestinal
recurrence requiring treatment, either at the outpatient department or admitted. In univariate
and multivariate regression analyses, factors influencing complication rates and recurrence
outcomes were investigated
During the study period, 184 patients underwent an ileocolic resection. Median follow-up was
4.2 years (inter quartile range: 1.5 – 7.2). Laparoscopy was performed in 107 patients (58%),
of whom 4 were converted to a laparotomy (3.7%). Direct postoperative complications
occurred in 35 patients (19%), significantly more often in patients who had open surgery
(23/77 (29.9%) vs. 12/107 (11.2%), OR 3.372 (95%CI: 1.555-7.310; p=0.002). Nine patients
required a reoperation due to postoperative complications (4.9%). After adjustment for case
mix (older age at time of diagnosis and at time of surgery and a temporary ileostomy after
primary resection) the only factor remaining associated with a higher complication rate in
multivariate analysis was open approach (OR 2.570 (95%CI: 1.118-5.911; p=0.026)). One
hundred-and-twelve patients (61%) remained relapse free after resection. Of the 72 (39%)
patients with recurrent disease, 59 could be treated in an outpatient setting. The remaining 26
patients (26/184: 14%) required a readmission and of those, 19 patients underwent a reresection (19/184: 10.3%). Median time between the ileocolic resection and re-resection was
63.75 months (inter quartile range: 26.8 – 71.2). In multivariate analysis, the only factor
significantly associated with relapse was an end-to-side anastomosis (OR 2.924 (1.294 6.606), p= 0.010). Smoking at time of surgery showed a trend to more relapses in this analysis
(OR 2.176 (0.923 - 5.131), p=0.076).
Conclusions: Ileocolic resection is a safe and effective treatment option in patients with
ileocecal Crohn’s disease, leading to low recurrence and re-resection rates.