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P288. Ileocolic resection: A safe and durable option for limited Crohn's disease of the terminal ileum

E.J. Eshuis, A. Kraima, C.Y. Ponsioen, P.C.F. Stokkers, W.A. Bemelman

Academic Medical Center, Amsterdam, The Netherlands

Aim: Aim of the present study was to assess the long-term results in patients who underwent an ileocolic resection for Crohn's disease.

Materials and Methods: All patients who underwent primary ileocolic resection within the period 1999–2009 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

Results: 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 (25%) 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 re-resection (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).

Conclusion Ileocolic resection is a safe and effective treatment option in patients with ileocecal Crohn's disease, leading to low recurrence and re-resection rates.