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* = Presenting author

P540. Does the time of ileocoecal resection have an influence on post operative recurrence?

M. Fekih1, B. Ben Slimène1, A. Laabidi1, M. Serghini1, N. Ben Mustapha2, J. Boubaker1, L. Kallel1, A. Filali1, 1La Rabta hospital; Tunis El Manar university, Gastro enterology “A”, Tunis, Tunisia, 2La Rabta Hospital, Gastro A Unit, Tunis, Tunisia

Background

Surgical resection is almost inevitable in Crohn's disease. Post operative recurrence is up to 30–50% at 5 years and 50 to 70% at 10 years. Ileo coecal resection is the most frequent surgical intervention in Crohn's disease. Some studies noted that an early surgery (patients in whom surgery was performed at the time of diagnosis) was associated with a reduced risk of clinical recurrence. The type of the ileo colonic anastomosis seems to be a predictive factor of post operative recurrence.

The aim of this study was to compare clinical outcome of patients undergoing early ileocoecal resection to those who had late resection and to determine if the type of ileo colonic anastomosis had an impact on post operative recurrence.

Methods

We conducted a retrospective study over 11 years (from 2000 to 2011). We included patients who underwent ileocecal resection during the study period. The data collected were: demographics and disease characteristics (location, phenotype) treatments, indications for surgery and postoperative recurrence.

Results

64 patients were included. There were 31 women and 33 men. The mean age at the first resection was 30.2 years. 8% had familial history of IBD and smoking was found in 32.8% cases. The indications for the resection were ileal obstruction in 40 cases (63%), enteric fistula in 2 (3.1%), enterocutaneous fistula in 2 (3.1%) and intra-abdominal abscess in 19 (29.7%). 43 Patients had an early surgery. The ileo colonic anostomosis was termino-lateral in 67.2%. During follow-up, 43.2% of patients developed a recurrence after surgery with the mean delay of 5 months. The sites of first recurrence were the preanastomotic ileum in 33.3%, the postanastomotic colon in 23.8%. Relapse rates were less frequent in those operated early 32.5% (14/43) VS those operated later 43% (9/21) p: 0.05.

Conclusion

An early ileo coecal resection was associated with a reduced risk of clinical recurrence in our study.