Abstract Background Crohn’s disease (CD) represents a rising global health burden, with growing incidence and prevalence in the last decades. Although drug therapies have evolved in the last years, surgery still represents a mainstay of the CD management, considering that half of patients will require at least one surgical intervention during their lifetime. Methods Our aim was to characterize the experience of Fundeni Clinical Institute in CD surgery during the last two decades. We retrospectively analysed patients hospitalized between 01 January 2004-15 August 2024 that underwent abdominal surgery for CD complications. The interventions for restoration of intestinal continuity were excluded. We collected data regarding demographics, clinical features, surgery rates, technical aspects, and postoperative outcome. Results We analysed 231 patients (39.7±15.2 years old; male 50.2%) that underwent 244 interventions (56.5% emergency, 41% stoma) (image). The main indications for surgery were lack of response to medical therapy (44.2%), abscess (16.8%), obstruction (15.9%), fistula (11%), neoplasia (5.3%), perforation (5.3%), and intestinal haemorrhage (1.2%). The most common interventions were ileocecal resection (27.4%), right hemicolectomy (20.9%), segmental enterectomy (20%), segmental colectomy (10.2%), total colectomy (5.3%), left colectomy (4.5%), and other (11.4%). The overall postoperative complications (POC) rate was 28%, with a mortality of 3%. In the subgroup of 69 patients with POC, the most frequent complications were wound infection (23.1%), fistula (20.2%), Clostridium difficile infection (15.9%), abscess (14.4%), sepsis (10.1%), and intestinal bleeding (8.6%); according to the Clavien-Dindo Classification, the POC subgroup developed grade I (26%), grade II (33.3%), grade III (21.7%), grade IV (5.7%), and grade V (11.5%) complications. Regarding prior surgical interventions, the POC rates were 21.8% (37 of 169) for first surgery, 34.8% (15 of 43) for second, 47.6% (10 of 21) for third, 50% (3 of 6) for fourth, 100% (1 of 1) for fifth, and 50% (1 of 2) for sixth. Although overall morbidity was not significantly different in emergency and elective surgery (30.3% vs.26.8%, p = 0.562), patients that underwent emergency surgery had higher rates of Clavien-Dindo grade III-V complications (18.1% vs.6.2%, p = 0.003), higher rates of stoma creation (56.5% vs.30.3%, p 0.001), and higher rates of postoperative reinterventions (11.1% vs.3.4%, p = 0.018), than those with elective interventions. Conclusion Abdominal surgical interventions for CD have become more frequent in the last two decades, mirroring the rising rates of incidence and prevalence. Postoperative morbidity was higher in patients with previous abdominal surgery and, also, in emergency surgery. References: 1. Frolkis AD, Dykeman J, Negrón ME, Debruyn J, Jette N, Fiest KM, Frolkis T, Barkema HW, Rioux KP, Panaccione R, GhoshS, Wiebe S, Kaplan GG. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysisof population-based studies. Gastroenterology. 2013 Nov;145(5):996-1006. doi: 10.1053/j.gastro.2013.07.041. Epub 2013 Jul27. PMID: 23896172 2. Ng, Siew C et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. The Lancet, Volume 390, Issue 10114, 2769 - 2778 Conflict of interest: Dr. Topala, Mihaela: No conflict of interest Stanciulea, Oana Maria: No conflict of interest Alshantti, Loai: No conflict of interest Ionescu, Victor: No conflict of interest Gheorghe, Cristian: No conflict of interest Shivaji, Uday Nagesh: No conflict of interest
Topala et al. (Thu,) studied this question.