Introduction
Despite significant progress in medical therapy, surgery remains a common treatment for Crohn's Disease (CD), particularly in cases with complications such as intestinal obstruction, fistulas, abscesses, or severe bleeding. A substantial proportion of patients require surgery within the first two decades after diagnosis, even with the widespread use of biological therapies.
Aims & Methods
This study is a retrospective, descriptive analysis spanning 8 years, from January 2015 to March 2024, conducted in a gastroenterology department of a university hospital. It includes all patients with Crohn's Disease who underwent surgery during this period. Data were collected from patient records, including demographics, disease characteristics, surgical indications, and treatment history.
This study evaluates the prevalence of surgical interventions and the primary indications for surgery in the era of biological treatments for Crohn's Disease.
Results
The study cohort comprised 292 patients diagnosed with Crohn's Disease, of whom 50 (17.12%) required surgical intervention. The median age at diagnosis among these surgical patients was 30 years, with a range from 9 to 64 years. The mean age at the time of surgery was 32 years (range: 16-64 years). Among the surgical cohort, 28 patients (54%) were male and 22 patients (46%) were female. Additionally, 7 of the 50 surgical patients (14%) had a prior history of appendectomy.
Regarding disease location, 16 patients (32%) had localized ileum involvement, while 42 patients (84%) had ileo-colic involvement. Notably, 13 of the surgical patients (26%) had perineal disease. Concerning the frequency of surgery, 38 patients (76%) underwent a single surgical procedure, 8 patients (16%) had two surgeries, 2 patients (4%) had three surgeries, and 2 patients (4%) required four surgical interventions.
Of the total surgical procedures, 18 (36%) were conducted on an urgent basis, indicating a significant proportion of acute complications. Regarding medication use prior to surgery, 6 patients (12%) were on corticosteroids, 21 patients (42%) were receiving immunosuppressants, and 5 patients (10%) were undergoing biological therapy.
The primary indications for surgery in this cohort were stenosis, accounting for 35 cases (67.3%), intestinal perforation representing 7 cases (13.5%), fistulation comprising 7 cases (13.5%), and abscess with 1 case (1.9%).
Conclusion
Despite the increasing use of biological therapies, surgery remains necessary for many patients with Crohn's Disease, with 17.12% of the study cohort requiring surgical intervention. The most common indications for surgery were stenosis, perforation, and fistulation, demonstrating the continued need for surgical management in patients with complex disease profiles. The relatively high rate of urgent surgeries (36%) emphasizes the need for timely and effective treatment strategies. The use of corticosteroids and immunosuppressants prior to surgery indicates that a multi-faceted approach to treatment is crucial. These findings highlight the ongoing importance of surgery in the care of Crohn's Disease and underscore the need for continued research to improve patient outcomes.
