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P141. Surgery during first 10 years of inflammatory bowel disease; our clinical experience

G. Can1, A. Tezel1, H.C. Ümit1, A. Üstündag1, G. Dökmeci1, A.R. Soylu1, 1Trakya University Hospital, Gastroenterology Department, Edirne, Turkey

Background

Surgery is not thought as the first-line treatment for inflammatory bowel disease (IBD) anymore after potent drugs come into use. But, it is continued to be used in necessary cases. While the rate of surgery in ulcerative colitis (UC) is 10–30%, the possibility of surgery in any stage of Crohn's disease (CD) is 75%. Our aim is to investigate causes, risk factors and the rate of surgery during first 10 years of CD and UC.

Methods

The clinical data collected from patients followed up between 1999–2012 in our clinic was retrospectively evaluated in terms of IBD and surgery. Statistical analysis was made.

Results

Surgery for IBD was performed in 33 (9.8%) of 335 IBD patients (24 (30.7%) for CD, 9 (3.5%) for UC). Surgery for IBD was higher in CD (p = 0.0001) (especially in obstructive and ileocolonic subtype of CD (p < 0.001 for each). Colectomy rates were higher in extensive type of UC (p < 0.0001). Of 9 operations in UC, 7 were total colectomy+ileal pouch anal anastamosis, 2 were total colectomy+ileostomy. Of 24 cases in CD, there was ileocecal resection in 8, perianal operation in 6 cases. Indication for surgery was “non-responded to medical therapy” for all cases of UC; as for CD, most frequent indication was “stenosis/ileus” with 11 cases (45.8%), others were “enterocutaneous fistula/malnutrition” and “perianal fistula/abscess“ with 5 cases each (20.8%). Most frequent perianal operation was “seton” (3 cases), others were fissurectomy, fistulectomy and perianal abscess drainage. Appendectomy was significantly higher in CD (p = 0.0001), but it was only performed in 44 cases (13.1%) (UC 4.3%, CD 29.5%). Number of non-IBD abdominal surgery was 82 (24.5%). Both non-IBD abdominal surgery and hemorrhoidectomy rate were higher in CD [33.3% (p = 0.038), 7.7% (p = 0.037)]. There was not any significant difference between CD and UC in terms of cesarean section (CS) (UC 38.5%, CD 42.1%) and other abdominal operations. Mean time between diagnosis and operation was 44.2 months, there was not significant difference between UC and CD (p = 0.101). The cumulative surgery rates during first 10 years of IBD are given in Table 1. It was found that surgery for IBD is associated with CS only in UC (p = 0.0034), appendectomy only in CD (p < 0.0001) and BMI in IBD (p = 0.016).

Table 1
 1. year5. year10. year
UC (colectomy)3/246 (1.2%)5/72 (6.94%)3/34 (8.8%)
CD (resectional surgery)7/77 (9.1%)15/35 (42.8%)9/17 (53%)

Conclusion

More potent and effective antiinflammatory drugs decrease the rate of surgery in both CD and UC.