Place de la chirurgie dans le traitement de la maladie de Crohn

The authors compare their experience in the surgical treatment of Crohn's disease with the results from several large series in the literature, Over 25 years 533 intestinal operations in adults were performed, including a first operation in 348 patients (177 women, 171 men, median age: 33 years, range: 15-80 years), with no mortality. The main indications for intestinal resection limited to macroscopic disease were symptomatic strictures (45.7%) and fistulas (37 %). As observed in other series reported, recurrences assessed as reoperations have been frequent, with a cumulative resection rate of 11% after 5 years, 29% after 10 years, 41% after 15 years and 70% after 20 years. However, 10-year cumulative reoperation rate was nil after coloproctectomy + ileostomy. In 18 patients, including 8 with previous surgery, 68 stricturoplasties were performed, associated with ileocolic and/or segmental jejuno-ileal resections in 15. After stricturoplasty, the reoperation rate was 33% over a median followup of 33.5 months (8-144). The confirmation of the high risk of recurrence after conservative surgery for Crohn's disease, which can only be reduced by cessation of smoking, urges the need to pursue randomized trials about post-surgical chemoprevention. If effective and safe, chemoprevention could allow even more conservative surgery, such as ileal-pouch anastomosis in patients with satisfactory anal sphincter function.